County New Rural Cooperative Medical Management Measures

The county's new rural cooperative medical management measures are to ensure the health of farmers in our county, and actively and steadily develop and improve the new rural cooperative medical care system in our county. According to the "Decision of the Central Committee of the Communist Party of China on Further Strengthening Rural Health Work" and the spirit of the Provincial Health Department, the Provincial Department of Finance, and the Provincial Agricultural Office's "Opinions on the Pilot Work of the New Rural Cooperative Medical Care", combined with the actual situation of the county, this pilot scheme was formulated. .

Chapter I General

Article 1: The new rural cooperative medical care system means that under the guidance, guidance and support of the government, farmers voluntarily participate in individual collective and government multi-party financing, and the county as the unit to manage the overall management. system. Farmers participate in cooperative medical care to fulfill their payment obligations and enjoy corresponding rights. Their payment is not considered to increase the burden on farmers.
Article 2: Cooperative medical care implements the working principles of “government responsibility, peasant participation, civil office assistance, county-run county management”; adheres to the principle of voluntary participation, multi-party financing, collection and support, appropriate protection, scientific management, and democratic supervision. The form of cooperative medical care is based on the overall hospitalization of major illnesses, and efforts are made to alleviate the pressure on farmers' hospitalization expenses.
Article 3: The principles of fairness, justice and universality.
Article 4: All units and individuals engaged in cooperative medical management and related to cooperative medical care must comply with these Measures within the administrative area of ​​the county.
Article 5: Cooperative medical care is included in the target management of the government and relevant departments, and is included in the planning of county and township economic and social development.

Chapter II Organization

Article 6: The county government establishes a new rural cooperative medical care coordination management leading group, responsible for leading and directing the county's cooperative medical work, organizing, coordinating, managing, supervising and inspecting the development of cooperative medical work. In the county health bureau, the new rural cooperative medical care management center of X× County was established, which is the cooperative medical service organization, which is responsible for the scheduling, approval, payment and use of the unified funds, and is fully responsible for the business of cooperative medical care.
Article 7: Townships and towns shall establish a cooperative medical coordinating management leading group headed by the township head, with an office under the head of the head of the office, the township finance, civil affairs, management, and health departments. Responsible for the implementation of all aspects of the township cooperative medical work. The administrative village should clarify that a principal person in charge should assist in the work of cooperative medical care.
Article 8: Rural cooperative medical supervision institutions shall be established in townships and towns. The rural cooperative medical supervision group consisting of the people's congresses, supervisors and representatives of farmers participating in cooperative medical care shall be responsible for supervising the management and use of the cooperative medical expenses of the townships and towns, and timely reflecting the villages. , make reasonable suggestions.

Chapter III Cooperative Medical Participation

Article 9: All agricultural populations living in the county may participate in cooperative medical care.
Article 10: Farmers participating in cooperative medical care shall be the unit of households, and family members must participate in all, and fulfill their payment obligations in accordance with regulations. All rural households applying for cooperative medical care shall go through the formalities of participation in the townships and villages in accordance with the relevant regulations of the county joint management center, and at the same time establish a roster of cooperative medical personnel. Cooperative medical care is officially launched on January 1 of each year, and one year is a cycle. Before the start of the farm, the hospitalization medical expenses of the farmers will not be subsidized. In principle, the procedures for participation will not be completed in the middle.
Article 11: The county joint management center issues the "cooperative medical certificate" for the farmers participating in the cooperative medical care, which is kept by the farmers, and establishes a cooperative medical file, and registers the cooperative medical fund fee subsidies paid by the farmers one by one.

Chapter IV Fundraising and Management

Article 12: Cooperative medical care strictly implements the financing mechanism of combining farmers' individual contributions, collective support and government funding. According to the current policy, the annual payment standard for farmers is 10 yuan. The central, provincial, municipal and county governments participate in cooperative medical care. The farmers each support 40 yuan per year.
Article 13: Set up a special fund account for cooperative medical care in the county finance, and manage the cooperative medical fund in accordance with the law in accordance with the principle of separate management and special funds.
Article 14: The township people's government is the responsible unit that organizes and mobilizes the broad participation of the people and collects the individual funds of farmers. The individual cooperative medical fund that the farmer should pay according to the regulations shall be uniformly collected by the village committee according to the number of agricultural population, and shall be uniformly put into storage by the township finance. The township finance office must be transferred to the county financial cooperation medical fund before the end of December of the previous year. Save accounts, no units or individuals may be squeezed and misappropriated.
Article 15: Encourage county, township and village economic organizations, social groups and individuals to fund cooperative medical care. The individual payment of the rural five-guarantee households participating in the cooperative medical care fund is partially solved by the civil affairs department, and the personal payment of the severely disabled person is partially resolved by the county Disabled Persons' Federation.
Article 16: The cooperative medical fund shall be uniformly managed by the county joint management center in accordance with the principles of openness, fairness, impartiality and special funds, with the principle of balance of income and expenditure, and establish a sound management and management rules for cooperative medical expenses. Carefully manage and timely review and pay for rural cooperative medical funds, and the annual savings of the cooperative medical fund account will be transferred to the next year.
Article 17: The wages and working expenses of the personnel of the county joint management center shall be arranged by the county finance and shall not be included in the cooperative medical fund.

Chapter V Medical Expenses Subsidy

Article 18: The medical expenses subsidy is temporarily limited to reimbursement of part of the hospitalization expenses according to regulations. The application for medical subsidy must meet the following conditions.
The households will pay the full amount of personal funds in one lump sum.
Inpatients in the county designated medical institutions for treatment or approved by designated hospitals, joint management centers to transfer to higher-level hospitals.
It is in line with the disease, the list of medications and the scope of examination for the major hospitalization cooperative medical assistance.
Article 19: The subsidy for the inpatient medical expenses of the participating persons shall be paid according to the following provisions:
The patient's medical expenses are subject to a single disease limit, and the scope of the drug subsidy is calculated by reference to the municipal drug medical insurance basic drug list. The proportion of deductible lines and subsidies in different levels of hospitals are: 100 yuan for township hospitals and central health centers, 60% for subsidies; 500 yuan for county-level hospitals, 50% for subsidies; provincial and municipal levels The hospital's deductible line is 1,000 yuan, and the subsidy ratio is 30%. Hospitalization outside the county is treated in the same way at the provincial and municipal levels. The hospitalization expenses incurred within the deductible line are not covered.
The maximum amount of medical expenses will be capped, and the maximum amount of subsidy will be 8,000 yuan per person per year. The per capita birth allowance for hospital delivery is 150 yuan per person, and the newborns born do not participate in the scope of subsidies. The TB patients who meet the free treatment of tuberculosis during the start of the project shall be treated according to the regulations of the project county. All the TB patients hospitalized for treatment shall be subsidized according to these Measures.
For patients who have repeatedly hospitalized multiple times, the cumulative annual medical expenses subsidy does not exceed 8,000 yuan.
The annual outpatient drug subsidy for patients with chronic organic disease is initiated after the improvement plan is completed.
Article 20: Subsidy Measures: The implementation of the unified management and review by the county joint management center and the payment of medical institutions by designated medical institutions. The county joint management center prepays a certain working capital monthly according to the business situation of the designated hospital. The medical expenses of the subsidized rated township hospitals at 1,000 yuan and the county's direct hospitals below XX are reviewed and subsidized by the designated hospitals. If the amount of subsidy exceeds the above-mentioned medical expenses, it shall be replenished by the designated hospital within one week after the audited by the designated hospital and the required information and documents to the county joint management center.

help.
Article 21: Subsidy Program: When an inpatient is hospitalized, it must be certified by the village committee, and the “Cooperative Medical Certificate” and the ID card of the household will be taken to the designated hospital to receive the “Cooperative Medical Expenses Subsidy Declaration Form”. The designated hospital manager will review and go through the admission procedure. The hospitalization medical expenses will be paid in full according to the requirements of the hospital, and will be redeemed after being examined at the designated hospital.
Article 22: In the process of going out to work in the county or in the process of visiting relatives and friends, the target person who needs to be hospitalized in the emergency department must report the detailed family address, the name of the head of the household, the gender, the age, the inpatient medical institution, and the telephone contact information to the county joint management center within two days. After verification and approval, they agreed to be hospitalized in a regular hospital in the field. At the time of discharge, they will go to the county joint management center for review according to the prescribed procedures, hospital invoices and detailed list, and apply for medical expenses subsidies at the county joint management center. The deductible line is 1,000 yuan, and the subsidy ratio is 30%.
Article 23: Patients who are unconditionally diagnosed and treated in this hospital should be referred to the hospital in time. If they need to transfer to the provincial or municipal hospital for treatment, they must go to the county joint management center to go through the examination and approval procedures. Transfer to the hospital. All persons who transfer to the hospital themselves are solely responsible for the expenses.
Article 24: Special auxiliary examinations, such as color ultrasound, ct, etc. and special treatment items, must be approved by the joint management center before they can be included in the reimbursement project.

Chapter VI Exclusions

Article 25: Fixed-point medical institutions must strictly control self-funded medical items and self-funded drugs. All self-funded medical items, nourishing drugs and non-therapeutic drugs, health-care drugs, and imported expensive drugs are self-funded, and they are less than 24 hours after admission. Patient medical expenses are not reimbursed.
Article 26: The following fees are self-care expenses and self-purchased medicines for the medical insurance exclusion of cooperative medical care.
The excess of the limit fee for a single disease.
Ambulance, blood transfusion, transportation, accommodation, food, accompanying, out-of-hospital consultation, nutrition, optician, air conditioning, incubator, special medical materials.
The cost of qigong treatment and various magnetic therapy, physiotherapy supplies and rehabilitation costs.
Medical expenses such as dental implants, beauty, surgical orthopedics, artificial organ replacement, and special treatment fees.
Hospitalization fees for senior wards and expenses for general wards.
Medical expenses incurred in fighting, drinking, self-mutilation, suicide, sexually transmitted diseases, drug abuse, etc.
Treatment costs caused by traffic accidents.
Medical expenses and medical expenses incurred due to work-related injuries, occupational diseases, and family planning operations.
Medical expenses for hospitalization that are not hospitalized at a designated medical institution, medical expenses for fraudulent activities such as impersonation or name hospitalization, dispensing, etc.

Chapter VII Medical Services and Responsibilities

Article 27: The County Health Bureau is responsible for the examination and approval of the designated medical institutions.
Article 28: The designated medical institution shall first apply by the hospital. According to the set standards promulgated by the provincial health department, the county health bureau shall, according to the combination of Chinese and Western medicine, specialties and comprehensive medical care, facilitate the examination and approval of the principle of peasants' medical treatment. After the contract is signed, the designated medical institution qualification certificate can be issued.
Article 29: Implement the annual service quality assessment system for designated medical institutions.
Article 30: Fixed-point medical institutions must set up cooperative medical work institutions, clarify the responsibility of special personnel, do a good job in medical service management, regularly announce the payment of cooperative medical funds, accept public supervision, strictly implement the relevant provisions of cooperative medical care, and improve medical personnel. Quality and quality of service.

Chapter VIII Supervision Mechanism

Article 31: The establishment of the New Rural Cooperative Medical Supervision Committee of the People's Congress, the Ministry of Supervision, Audit, Finance, Price, Health, Drug Administration and other relevant departments. Responsible for supervising the audit revenue and expenditure, budget and final accounts, checking the service status of medical institutions, and cooperating with the discipline inspection and supervision judicial organs to investigate and deal with illegal activities in cooperative medical care. The County Commission for Discipline Inspection shall formulate disciplinary regulations related to cooperative medical care.

Chapter IX Rights and Obligations

Article 32: Those who participate in cooperative medical care have the following rights:
Have the right to enjoy the prescribed medical services and fee subsidies;
Have the right to supervise the management and use of cooperative medical funds;
Have the right to criticize and advise on the management of cooperative medical care;
Article 33: Those who participate in cooperative medical care have the following obligations:
Comply with and maintain the charter and related regulations of cooperative medical care;
Pay the cooperative medical fund in full and on time;
Properly keep relevant documents and vouchers for cooperative medical care;
Reporting impersonation, malpractice, fraud, and sabotage of cooperative medical care.

Chapter X Punishment of Violation

Article 34: Anyone who has one of the following circumstances shall, in accordance with the circumstances of the case, conduct a quits conversation, determine the object of unqualified annual assessment, dismissal or diversion, until the transfer of discipline inspection, supervision and judicial organs according to law. deal with.
Irrespective or negligent due to work;
Not in accordance with the policy and operating procedures;
Misappropriation, seizure, and retention of cooperative medical funds;
Intentionally delaying the redemption and requesting benefits from the patient;
Applying and transferring the funds allocated for cooperative medical care, resulting in a shortage of compensation;
Providing false evidence or knowing not to report to others and relatives and friends;
Unauthorized changes to standards to increase or decrease the standard of compensation;
There are other violations.
Article 35: The designated medical institutions and medical personnel shall have the following acts, and shall give notices of criticism according to the seriousness of the circumstances, deducting 2-5 times of the amount of non-compliance declaration subsidies, and cancel the qualifications of designated hospitals for cooperative medical treatment for units that are not allowed to be rectified within the time limit. In addition to a certain amount of economic responsibility, the illegal handling personnel and medical personnel shall be given administrative sanctions according to the seriousness of the circumstances until they are dismissed or expelled.
In the case of diagnosis and treatment, accounting is not handled in accordance with the provisions of the cooperative medical care, and non-medical items or expenses are recorded in the account of the cooperative medical fund;
The medical expenses that should be paid by the individual are recorded in the cooperative medical subsidy account;
Not strictly implement basic medical diagnosis and treatment catalogues, medication catalogues, overcharged standards, and violations of regulations, excessive prescribing, randomization, large prescriptions, prescriptions, and drug withdrawals;
Do not implement the routine or single disease management regulations, do not adhere to the admission criteria, will not meet the admission of patients to hospital treatment or arbitrarily extend the length of hospital stay, use the name of hospitalization, fake medical records, segmentation accounting, etc. to increase cooperative medical care Fund expenditure.
Article 36: If there are any violations of the following objects, the order shall be returned to the medical expenses that have been paid, and the annual cooperative medical treatment shall be terminated in the case of serious circumstances.
Using a false medical fee receipt and prescription to take the cooperative medical fund;
Privately altering, copying medical expenses receipts, medical records, prescriptions, inspection reports or instigating medical staff to falsify;
Use someone else's credentials to see a doctor or transfer your credentials to someone else.

Chapter XI Supplementary Provisions

Article 37: The County Cooperative Medical Coordination Management Leading Group guides the county's rural cooperative medical management. Its main duties are to comprehensively implement the relevant policies and regulations on rural cooperative medical care, and formulate and improve the relevant regulations and systems for rural cooperative medical care.
Article 38: The County Health Bureau is the competent department of the new rural cooperative medical service. According to these "Measures", the "Implementation Rules", the management methods for designated hospitals for cooperative medical care, and cooperative medical diseases are formulated.

Fees and their standards, drug catalogs. And reported to the County Cooperative Medical Management Coordination Leading Group for approval.
Article 39: The county joint management center shall provide guidance to the propaganda and organization of the township and village cooperative medical work, the participation of the people, and the collection of funds, and regularly report the dynamics.
Article 40: These Measures shall be interpreted by the County Rural Cooperative Medical Management Center.
Article 41: The "Measures" will be tried on January 1, XX.