Interim measures for urban and rural medical assistance in Heilongjiang Province
Chapter I General Principles
Article 1 In order to further improve the medical assistance system, according to the "Interim Measures for Social Assistance" (State Council Decree No. 649) and the "Office of the State Council transmits to the Ministry of Civil Affairs and other departments on the further improvement of the medical assistance system on the comprehensive implementation of the views of the work of the medical assistance for serious illnesses notice" ( State Office Development [2015] No. 30) and other documents, combined with the actual situation in our province, the formulation of this approach.
Article 2 urban and rural medical assistance to follow the following principles:
(a) the level of medical assistance in line with the level of economic and social development, scientific and reasonable development of the assistance program to ensure that the aid recipients receive the necessary medical assistance services.
(2) to promote the integrated development of the medical assistance system in urban and rural areas, and to strengthen the effective connection with the basic medical insurance for residents, urban and rural residents' major illness insurance, emergency relief for illnesses, and various types of supplemental medical insurance, commercial insurance system, to form a synergistic system; to strengthen the orderly connection with charitable undertakings, and to form a highly effective linkage between the government's assistance and the participation of the social forces and benign interactions.
(3) adhere to the rescue policy, work procedures, rescue targets and implementation of public, and actively accept the public and social supervision, to ensure that the process is open and transparent, the results are fair and impartial.
(d) Optimize the relief process, simplify the settlement procedure, strengthen the construction of information technology, and enhance the effectiveness of relief.
(e) Focused, categorized assistance, on the basis of the bottom line, and constantly improve the level of medical assistance, and strive to reduce the burden of medical care for people in need.
Article III of the medical assistance to implement the local government responsible for the system, led by the civil affairs departments at all levels responsible for the implementation of human society, health planning and other departments in accordance with the division of responsibilities to do the relevant work. Medical assistance to implement local management. Governments at all levels should provide the necessary organizational conditions and material support for medical assistance.
Article IV of the definition of medical assistance objects:
(a) special hardship to support people and members of the minimum subsistence guarantee (hereinafter collectively referred to as key assistance objects).
(b) gradually low-income families of the elderly, minors, severely disabled and seriously ill people in need (hereinafter collectively referred to as low-income recipients of assistance), as well as other special difficulties specified by the government at or above the county level into the scope of assistance.
(C) appropriate to expand the scope of medical assistance for serious illnesses, and actively explore the incidence of high medical costs, more than the family's ability to afford, the basic life of serious illnesses in families with serious difficulties (hereinafter collectively referred to as the disease caused by the poverty of the family with serious illnesses) implementation of the assistance.
Among the various types of recipients of assistance, the focus on increasing the assistance for people in special hardship, seriously ill, seriously disabled children.
Chapter II Subsidies to participate in insurance participation
Article 5 of the urban and rural special hardship to fully subsidize the urban and rural residents to participate in basic health insurance or new rural cooperative medical care; the minimum subsistence guarantee family members to participate in basic health insurance for urban residents or new rural cooperative medical care to give a fixed amount of subsidies.
Article 6 The specific funding methods shall be studied and formulated by the municipal and county governments according to the level of local economic and social development and medical aid financing and other factors.
Chapter III hospitalization assistance
Article 7 The key assistance recipients to abolish the starting line of medical assistance.
Article 8 The key aid recipients in the policy scope of hospitalization expenses incurred by the designated medical institutions, the basic medical insurance, urban and rural residents of major medical insurance and various types of supplemental medical insurance, commercial insurance reimbursement of the personal burden of the costs, within the annual limit of aid in accordance with the proportion of not less than 70% of the aid, the annual cumulative amount of aid does not exceed the annual maximum limit of aid (hereinafter referred to as the aid). (hereinafter collectively referred to as the cap line).
Article IX of the hospitalization aid relief ceiling by the government at or above the county level in accordance with the needs of the aid recipients and funding and other circumstances to study and determine.
Chapter IV outpatient assistance
Article 10 outpatient assistance focuses on chronic diseases requiring long-term medication or suffering from serious diseases requiring long-term outpatient treatment, resulting in higher out-of-pocket expenses of medical assistance recipients.
Article 11 The government at or above the county level according to the need for medical assistance and funding to determine the outpatient assistance ceiling.
Chapter V. Relief for serious illnesses
Article 12 comprehensively carry out relief work for serious illnesses, the key relief objects suffering from serious illnesses, low-income relief objects and families suffering from serious illnesses due to poverty, the basic medical insurance, urban and rural residents of the major disease insurance and various types of supplemental medical insurance, commercial insurance, etc., reimbursement of the individual's personal burden of the compliance of the medical costs of the implementation of the serious illnesses. Relief.
Article 13 of the poverty caused by disease family income level, family property identification conditions by the local government combined with low income family identification standards and other factors to be determined; *** with the identification of family members should be in line with the "Heilongjiang Province," the minimum subsistence guarantee review and approval approach (for trial implementation) 〉 Implementing Rules "relevant provisions.
Article 14 Reasonable determination of relief standards for serious illnesses.
(a) in principle, the focus of the object of assistance is higher than the proportion of low-income recipients, low-income recipients of assistance is higher than the proportion of low-income recipients of assistance is higher than the proportion of poor families due to illness, such as serious illnesses, and other recipients of assistance. The key relief objects should be completely canceled relief threshold, because of the illness of poor families with serious illness relief can be set up relief threshold, the threshold above the out-of-pocket expenses to give relief. In principle, the same type of object of assistance, the greater the amount of personal out-of-pocket expenses, the higher the proportion of assistance.
(b) The government at or above the county level should take into account the affordability of the sick family, the amount of personal out-of-pocket expenses and local financing, etc., and set the proportion of medical assistance for serious illnesses and the relief ceiling, and reasonably determine the starting line of assistance for serious illnesses in families that have been impoverished due to illnesses.
Article 15 The aid recipients who really need to be referred to higher-level designated medical institutions, foreign designated medical institutions and other designated medical institutions that do not realize instant settlement for medical treatment, should fulfill the referral or record procedures in accordance with the provisions. After the end of the treatment with the relevant documents to the place of residence in accordance with the provisions of the relevant procedures for medical assistance.
Article 16: The other aid recipients, such as patients with serious illnesses from poor families due to illnesses, should first pay for their regular medical expenses, and then provide assistance for the part that exceeds the family's affordability. Compliance with medical costs are mainly determined by reference to the relevant provisions of the local basic medical insurance, urban and rural residents to carry out urban and rural residents may refer to the relevant provisions of the urban and rural residents of the major disease insurance to determine.
Chapter VI Other Relief
Article 17 Charity Relief. Charitable management departments at all levels to explore the establishment of a special fund for medical assistance, in accordance with the provisions of the relevant poor families to carry out charitable assistance programs at the same time, to carry out charitable assistance for the medical assistance after the cost of assistance is still a heavy burden.
Article 18 Preferential exemptions. Medical aid recipients in the designated medical institutions, the designated medical institutions should be in accordance with the relevant provisions of the outpatient registration fees, treatment fees, medical equipment inspection fees, hospital bed fee reductions and other concessions.
Chapter VII Management and Services
Article 19 of the key objects of assistance and low-income objects of medical assistance application, review and approval procedures in accordance with the relevant provisions of the provincial Civil Affairs Bureau. Poverty caused by disease family patients applying for medical assistance for serious illnesses application, review and approval time limit should not exceed 30 working days.
Article 20 The establishment of medical assistance and basic medical insurance, urban and rural residents of major illness insurance, emergency relief, various types of supplemental medical insurance, commercial insurance, designated medical institutions and each other's "one-stop" exchange of information and instant settlement mechanism, simplify the relief process, improve the efficiency of relief.
Article 21 The implementation of designated medical institutions to instantly settle medical assistance costs, and actively explore the implementation of the instant settlement of medical treatment in other places.
Article 22 to establish and improve the medical assistance object file, a household file, medical assistance object application, review and approval form, diagnosis, medical invoices and other information is complete, standardized management.
Article 23 of the medical institutions to provide medical assistance services, within the scope of the provisions of the basic medical insurance in accordance with the catalog of medicines, diagnostic and treatment items and medical service facilities directory, to provide services for the medical object, the implementation of health care preferential policies and preferential items and preferential range to be announced, to guide the assistance object reasonable medical treatment.
Chapter VIII fund-raising management
Article 24 Each region should be in accordance with the "Provincial Department of Finance, Provincial Department of Civil Affairs on the transmittal of the Ministry of Finance, Ministry of Civil Affairs on the issuance of the" urban and rural medical assistance fund management methods "notice" (Hei Cai She [2014] No. 11), do a good job of urban and rural medical assistance fund-raising and the use of the management of expenditure, civil affairs, finance, Health and Family Planning and other departments to effectively increase the supervision and inspection of the medical aid fund, and consciously accept the audit, supervision departments.
Article 25 The accumulated balance of the medical aid fund should not exceed 15% of the total amount raised in the year.
Article 26 The payment of medical aid funds should take the financial direct payment management. Has carried out immediate settlement of the region, the aid object is expected to incur medical expenses can be paid by the medical aid fund payment department in advance to the designated medical institutions, to be the end of the medical aid, and then in accordance with the actual amount of settlement procedures; not carry out immediate settlement of the region, by the financial sector will be the medical aid funds allocated to the relevant financial institutions, the implementation of the socialization of the issue.
Chapter IX Supplementary Provisions
Article 27 The implementation of medical assistance review and approval of the public system, accept social supervision, open, fair and just.
Article 28 These measures shall come into force on the date of promulgation. Has been issued by the relevant provisions of the inconsistency of these measures, in accordance with the implementation of these measures.
Harbin City introduced a new policy to further improve and perfect the temporary assistance system. From now on, residents who encountered unexpected events, accidental injuries, major illnesses and other situations difficult to maintain a basic life, you can apply for individual or family temporary assistance, to tide over the temporary difficulties. The maximum annual assistance standard shall not exceed 10 times the monthly standard of the local urban low income insurance, and the maximum number of times in the same year shall not exceed two.
Scope of assistance
Divided into two categories of family and individual objects
Family objects for the minimum subsistence guarantee families; low-income families; due to the family into an emergency, distress predicament, the basic life of other residents of urban and rural areas temporarily serious difficulties, as well as non-local residents holding local residence permits; district, county (city) government to determine the other special difficulties of the family.
Individuals targeted for special hardship support staff; individuals who are temporarily unable to receive family support due to fire, traffic accidents, sudden major illnesses, or other special difficulties, resulting in basic life in distress; other individuals with special difficulties as determined by the district, county (city) governments.
Conforms to the conditions of the homeless and beggars, according to the relevant provisions of the homeless and beggars rescue by the rescue management organization to provide temporary accommodation, emergency treatment, assistance in returning to the rescue and other assistance. Due to natural disasters, accidents and calamities, public **** health, social security and other emergencies and public **** events, the need to carry out emergency relocation and basic life assistance, as well as belonging to the scope of the emergency relief of disease, in accordance with the relevant provisions of the implementation.
Relief methods
Send relief money, send in kind, provide referral services
Issue of temporary relief money - districts, counties (cities) to fully implement the socialization of relief money, temporary relief money paid directly to the individual account of the relief object, to ensure that the relief money in full and in a timely manner to be issued in place. If necessary, cash can also be issued directly.
In-kind assistance - according to the standards of temporary assistance and the basic needs of the assistance recipients, can be provided with clothing, food, drinking water and other necessities of life, or provide temporary housing and other means of assistance.
Provision of referral services - for the temporary relief funds, in-kind assistance can not solve the difficulties of the temporary assistance recipients, can be divided into circumstances to provide referral services. Among them, in line with the minimum subsistence guarantee, special hardship cases or medical, education, housing, employment and other relief conditions, the township government (street office) should assist its application; the need for public welfare and charitable organizations, social work service agencies to provide services to the special difficulties of the object, according to the specific circumstances of the corresponding referral services to be provided to them.
Relief standards
Annual relief of up to 10 times the local monthly minimum standard
District and county (city) governments in accordance with the urban and rural minimum subsistence standards, taking into account the type of assistance, the degree of difficulty, the family size, and time to tide over the difficulties and other factors, combined with the level of protection of the other social assistance system, to reasonably determine the temporary relief standards, and adjusted in due course.
Generally speaking, the maximum annual standard for temporary assistance for the same family or individual shall not exceed 10 times the monthly standard of the local urban subsistence allowance, and shall not exceed two times in the same year. For special events, special objects of assistance, to take a case by case approach, determined by the district and county (city) governments.
Temporary relief
It is an acute, transitional relief given by the state to families or individuals who have suffered an unexpected event, accidental injury, major illness or other special reasons that have caused their basic lives to be in a difficult situation, and who are temporarily unable to be covered by any other social assistance system, or who are still experiencing serious difficulties in their basic lives after receiving such assistance.
4 kinds of cases can apply for temporary relief
Family property suffered major losses due to fire, traffic accidents and other sudden accidents, resulting in temporary serious difficulties in basic life.
Because of sudden major diseases, medical expenses are too high, resulting in serious difficulties in basic living.
The increase in expenses for children's schooling is beyond the family's ability to bear, resulting in serious temporary difficulties in basic living.
District and county (city) governments to determine other assistance matters.