Pastoral Area Of Inner Mongolia Autonomous Region, The New Rural Cooperative Medical Management

Original Language Title: 内蒙古自治区新型农村牧区合作医疗管理办法

Read the untranslated law here: http://www.chinalaw.gov.cn/article/fgkd/xfg/dfzfgz/201307/20130700388829.shtml

Pastoral area of Inner Mongolia autonomous region, the new rural cooperative medical management

    (January 23, 2013 Executive meeting of the people's Government of Inner Mongolia autonomous region, 1th to consider February 20, 2013, the people's Government of Inner Mongolia autonomous region to 194th published since March 1, 2013) Chapter I General provisions

    First to ensure basic medical services for farmers and herdsmen, maintaining participation in the new rural cooperative medical personnel in pastoral areas (hereinafter referred to as the participant), the legitimate rights and interests, in accordance with the relevant laws and regulations, combined with State practice, these measures are formulated.

    Article mentioned in the procedures of the new rural CMS in pastoral areas, is run by a Government Organization, guidance, support, voluntary participation of farmers and herdsmen, follows the open, fair, equitable access to basic principle of Huimin depression, convenience, security, according to personal and collective support, Government grants and other ways to raise funds, establishing the basic medical insurance system for the rural area residents.

    Article autonomous region within the administrative area of the new rural cooperative medical application of this approach in pastoral areas.

    Fourth implementation of new-style rural cooperative medical service in Union City in the pastoral area of the autonomous region level to co-ordinate system.

    Article fifth people's Governments above the county level shall include new rural area cooperative medical work in local economic and social development plan, establish and improve the coordination mechanism of new rural CMS in pastoral areas work, raise new-style rural cooperative medical care funds in pastoral areas. Article sixth flag above the county level in the Administrative Department of health under the administration of new rural CMS in pastoral areas.

    New-style rural cooperative medical agencies in the pastoral area (hereinafter referred to as the Agency) is responsible for the daily work of new rural CMS in pastoral areas.

    Development and reform, finance, audit, administration, human resources and social security, agriculture and animal husbandry, and other relevant departments according to their respective duties well relevant work of new rural CMS in pastoral areas.

    Article seventh Township Township people's Government, the subdistrict office specifically responsible for the new rural CMS in pastoral areas of the Organization, funding, publicity, publicity and other related work.

    Villagers ' committees, neighborhood committees to assist the Township the Township people's Government, the subdistrict office of new rural CMS in pastoral areas.

    Eighth people's Government above the county level and their departments in the pastoral areas in new rural cooperative medical care have made outstanding contributions to the units and individuals should be commended and rewarded.

    Chapter II participants

    Nineth autonomous region within the administrative area of rural area residents volunteered domicile, in households of new rural CMS in pastoral areas.

    Have other basic medical insurance, shall participate in the new rural CMS in pastoral areas.

    Article tenth did not participate in the medical insurance for urban residents and urban residents living in the Township Township may voluntarily opt for domicile or pastoral areas now living in the new rural cooperative medical system.

    11th with the rural and pastoral areas of the autonomous region residence but live non-domicile in the State for more than a year, and did not participate in the domicile of the new rural cooperative medical personnel in pastoral areas, you can choose in the pastoral area of residence to participate in the new rural cooperative medical care.

    Article 12th rural household registration in the pastoral area of nursery school children, elementary and middle school students should be in school with their father, mother or guardian in households participating in new rural CMS in pastoral areas.

    13th to participate in the new rural cooperative medical personnel in pastoral area payment in accordance with regulations, agencies shall be registered as a participant, enjoy annual payment in new rural cooperative medical treatment in pastoral areas, not complying with the provisions payment deemed to surrender.

    14th baby was born the year exempt personal cost in new rural CMS in pastoral areas, with their father or mother to enjoy the new rural cooperative medical treatment in pastoral areas.

    15th participants enjoy the following rights:

    (A) in accordance with the regulations of medical expenses;

    (B) query, check payment and obtain reimbursement;

    (C) awareness of new rural cooperative medical fund raising in pastoral areas and use;

    (D) participate in the new rural cooperative medical supervision in pastoral areas;

    (E) other rights stipulated by laws and regulations.

    16th participants to fulfil the following obligations:

    (A) paid their fee for participating in new rural cooperative medical personal in pastoral areas;

    (B) comply with the new rural CMS in the pastoral area rules and regulations;

    (C) medical treatment and medical expenses reimbursement provide truthful information when I related data and information;

    (D) other obligations under laws and regulations.

    Chapter fund raising and management

    17th new rural cooperation medical system Fund in pastoral areas include:

    (A) the personal contributions of participants;

    (B) the financial assistance fund;

    (C) the rural areas support funds of collective economic organizations;

    (D) community Endowment Fund;

    (V) interest income;

    (Vi) other sources.

    18th article of the new rural cooperative medical financing standards in the pastoral area shall not be less than the minimum funding standards prescribed by the State, and with the increase of economic and social development.

    Article 19th novel cooperative medical personal contributions to carry out advance system in rural and pastoral areas, and raise individual contributions next year when funds raised once a year, concentrate on December 20 deadline for payment, special reasons within the specified time may be extended to the last day of February next year.

    Article 20th Township Township people's Governments and neighborhood offices or on their behalf of villagers ' committees and residents ' Committee for the collection of individual contributions, the Agency may authorize financial institutions to collect payment.

    Charges shall be issued by the financial Department of the autonomous region to pay people printed exclusively dedicated to pay bills, transfer of funds to the new rural cooperative medical fund account in pastoral areas.

    Article 21st rural area five, orphans to participate in the new rural cooperative medical personal in the pastoral area fully funded by the civil affairs departments of medical relief fund.

    Rural and pastoral areas to basic living allowances, key entitled groups to participate in the new rural cooperative medical personal in the pastoral area by the civil affairs departments of medical relief fund in accordance with the standard of not less than 50 Yuan per capita funding.

    22nd article in addition to the central financial subsidy funds, new rural area cooperative medical financial assistance should be funded by State, Union City, flag borne by County finance in accordance with the relevant provisions.

    23rd levels of financial assistance fund shall, in accordance with the provisions in full and on time allocated to pooling area new rural cooperation medical system Fund in the pastoral area of financial accounts.

    24th new type rural cooperation medical system Fund in pastoral areas carry out two lines of income and expenditure management, account store, establish accounts separate, earmark, any entity or individual may intercept or appropriate, may.

    The fourth chapter funds and medical treatment

    25th Union City, banner County new rural cooperation medical system Fund in the pastoral area of financial accounts, unified management and accounting of the new rural cooperation medical system Fund in pastoral areas.

    Article 26th overall area shall be in accordance with the provisions in the new rural cooperation medical system Fund in pastoral areas extract risk fund, extraction of risk funds shall not exceed that year's total of Fund 3%, 10% today calendar year shall not exceed the total funds that year.

    27th new rural cooperation medical system Fund in pastoral areas the year funds (including venture capital) balance shall not exceed the total Fund of 15% that year, cumulative balance of the calendar year shall not exceed the total Fund of 25% that year, the excess should be to get medical expense compensation participants again. 28th article of the new rural cooperation medical system Fund in pastoral areas are divided into hospital funds and clinic funds in two parts.

    Funds used in hospital ratio shall not be less than that year's Fund 70%, clinic funds ratio shall not be less than that year's Fund 20%, and according to the funding situation and adjusting the relevant provisions.

    Article 29th included in the new rural cooperative medical fund in the pastoral area of hospitalization expenses annual maximum limit may not be lower than standards set by the State.

    Article 30th into the scope of new rural cooperative medical fund in pastoral areas above the hospital medical expenses paid in accordance with the provisions of part reimbursement, paid line following by the participants themselves.

    31st appointed medical institutions of participants in the clinic outpatient costs within the scope of the Fund in accordance with the provisions to be reimbursed.

    Participants in the 32nd after payment of hospitalization expenses pay part, partial reimbursement by the designated medical institutions an instant knot, agencies designated medical institutions settlement advance funding on a regular basis.

    33rd agency can advance for designated medical institutions to provide the necessary funds.

    Article 34th in accordance with principles of medical grade visits, participants will be free to choose within the overall area of new-style rural cooperative medical care fixed-point medical institutions of pastoral visits.

    Article 35th of participants hospitalized for illness require referral to co-ordinate areas treated shall be specified by the operator appointed medical institutions of two or more levels and proof of referral, referral formalities and to agencies in their respective districts.

    Article 36th participants since the conditions of emergency, first aid, danger, or special cause, in the integrated areas or designated medical institutions for treatment, participants, or their attorneys, shall, within the 5th, told participants the respective agencies.

    Article 37th article 35th of this approach, one of the circumstances set forth in article 36, participants in accordance with provisions in their co-ordinating agency reimbursement of medical costs, agencies should be audited within the 30th junction, had reservations to verify a certain difficulty, may be extended to 60 days review node.

    Article 38th rural area medical aid by the new rural cooperative medical compensation for out-of-pocket expenses in pastoral areas, the local Civil Affairs Department in accordance with the provisions to help.

    39th State Administrative Department of health under the development of the new rural cooperative medical drug claims of pastoral directory and treatment projects list of claims, and to the public.

    40th new rural area cooperative medical reimbursement conditions, coverage, reimbursement by the co-ordinating regional health funding, financial sector according to adjust and to the public.
41st under any of the following circumstances, medical expenses not included in the new rural cooperation medical system Fund in pastoral areas eligible for reimbursement:

    (A) the use of medicines, medical items are not included in the new rural cooperative medical drug claims of pastoral directory, list of projects reimbursement of diagnosis and treatment;

    (B) should be borne by a third person for medical expenses;

    (C) shall be borne by the public health;

    (D) overseas visits;

    (E) the medical expenses for the injury itself is due to intentional crimes;

    (Vi) for cosmetic, plastic and other non-medical costs of basic medical needs;

    (VII) is not in accordance with the relevant provisions of referral procedures to co-ordinate areas for medical treatment;

    (H) the State and the autonomous communities shall not be reimbursed under other circumstances.

    The fifth chapter designated medical institutions

    42nd health Administrative Department in accordance with medical care, reasonable layout, appropriate technology, fair and just determined designated medical institutions.

    Article 43rd appointed medical institution shall meet the following conditions:

    (A) lawfully obtained the practising certificate for medical institution;

    (B) providing medical services in line with the new rural cooperative medical requirements in pastoral areas;

    (C) the charges for medical services in accordance with the relevant provisions;

    (D) full-time or part-time staff equipped with necessary equipment and used to settle medical expenses.

    (V) hospital HIS system with the new type of rural cooperative medical care system more seamless in the pastoral area.

    List of designated medical institutions shall be announced to the public, valid for two years.

    44th the Agency should work with fixed-point medical institutions of new rural cooperative medical care fixed service agreements in the pastoral area, clear rights and obligations.

    Article 45th designated medical institutions shall perform the following duties:

    (A) timely diagnosis and treatment of new-style rural cooperative medical patients in the pastoral area;

    (B) to verify the true identity of the new rural cooperative medical patients in the pastoral area;

    (C) for the new type of rural cooperative medical patients in the pastoral area health education project FAQ, policy advice, diagnosis and treatment services;

    (D) the implementation of the new rural and pastoral areas issued by the administrative departments of public health cooperative medical reimbursement of essential drugs list and clinic projects reimbursement list; (e) strict implementation of the State and the autonomous communities to develop medical standards and practices;

    (Vi) publicity of new rural CMS in the pastoral area of fees and prices and payment conditions and procedures, coverage, reimbursement, etc.

    (VII) comply with the provisions of new rural cooperative medical management in pastoral areas.

    Article 46th designated medical institutions and medical personnel shall not be any of the following acts:

    (A) the participants in the non-medical expenses in new rural cooperative medical fund in the pastoral area of coverage;

    (B) participants shall be personally liable for medical expenses in new rural cooperative medical fund in the pastoral area of coverage;

    (C) beyond the need to check the patient's condition, medication and treatment;

    (D) unauthorized raising fees, fee increase;

    (E) fraud obtain new rural cooperation medical system Fund in pastoral areas;

    (Vi) other acts in violation of new-style rural cooperative medical care provided in the pastoral area.

    Sixth chapter guarantee and supervision

    47th flag the people's Governments above the county level shall include new rural area cooperative medical work in the annual performance evaluation goals.

    48th agencies handling the people's Governments above the county level shall safeguard the basic conditions of service, staffing, operational requirements, and so on, its functions and operations and adapt to it.

    49th appointed medical institutions of health Administrative Department should develop evaluation criteria, implement credit rating assessment and evaluation results known to the public.

    50th audit, finance, supervision departments should be on the new rural cooperation medical system Fund in pastoral areas of expenditure, management, supervision and inspection, and publicize the results.

    51st pricing departments should be appointed medical institutions of the medicines and medical services price management and supervision.

    52nd agencies shall establish and publish the new rural CMS in pastoral areas supervisory telephone hotlines and complaint box, receiving complaints and reports.

    53rd agencies should be public at least once a year of the new rural cooperative medical fund in pastoral areas raise, use.

    The seventh chapter legal liability

    54th new rural cooperative medical personal contributions to the collection of units and their staff in pastoral areas have one of the following acts, the competent authority shall order correction within and directly responsible shall be disciplined in charge and other direct liable persons:

    (A) failing to collect participant contributions;

    (B) is not in accordance with the provisions for the payment instrument issued by the participants;

    (C) failing participants to pay the cost of the new rural cooperative medical fund account in pastoral areas;

    (Iv) interception, misappropriation, misappropriation of participant contributions;

    (E) violation of the provisions of the new rural cooperative medical fund in pastoral areas.

    55th to defraud new rural cooperation medical system Fund in pastoral areas, returned by the health Administrative Department in charge shall command and illegal gains more than 1 time penalty of three times, up to 30,000 yuan.

    56th article of the new rural cooperative medical care fixed-point medical institutions and their staff in the pastoral area of any of the following acts, rectification by the health administrative departments and designated medical institutions up to 3000 Yuan and 10,000 yuan fine, are directly responsible for the charge and the other persons given a warning and a fine of 2000 more than 5000 Yuan fines;

    (A) without reasonable grounds to refuse to participate in person in the hospital;

    (B) to provide the participants with illnesses unrelated to the examination, treatment and drug services;

    (C) the new rural cooperative medical drug claims of pastoral directory or clinic within the list of projects reimbursement costs to participate in personal burdens;

    (D) the new type of rural cooperative medical drug claims of pastoral directory or medical reimbursement claims outside of the costs included in the scope of the project;

    (E) without the consent of participants, the use of new rural cooperative medical drug claims in pastoral areas outside of the drug or implementation of projects list of claims outside the clinic diagnosis and treatment projects;

    (F) hospitalization expenses for qualified participants;

    (VII) participant that does not meet the referral criteria referrals or not timely for participants eligible for referral referral procedures;

    (VIII) other violations of the provisions of the new rural cooperative medical management in pastoral areas.

    57th new type rural cooperative medical care fixed-point medical institutions and their staff in pastoral areas have one of the following acts, by the Administrative Department of public health ordered to return the illegal gains and illegal gains more than 1 time penalty of 3 times, up to 30,000 yuan; for supervisor directly responsible and other persons directly responsible shall be given administrative sanctions:

    (A) non-participants will be included in the reimbursement of medical costs;

    (Ii) destruction, concealment, falsification of medical documents;

    (Iii) other illegal activities.

    Article 58th one of the agencies and their staff to any of the following acts, rectification by the health Administrative Department, and the supervisor directly responsible and other persons directly responsible shall be given administrative sanctions:

    (A) is not in accordance with the provisions of real-name registration for participants;

    (B) is not within the specified time for the participants of the reimbursement of medical expenses;

    (C) the interception, misappropriation, invasion of new rural cooperation medical system Fund in pastoral areas;

    (D) violation of the new rural cooperative medical fund management system in pastoral areas, resulting in loss of funds;

    (E) violation of regulations, reimbursement of costs of new rural CMS in pastoral areas;

    (Vi) other illegal activities.

    59th health administrative departments and related departments and dereliction of duty, abuse of power, favoritism, and disciplined by their work units or by the competent authorities.

    60th in violation of these rules constitutes a crime, criminal responsibility shall be investigated according to law.

    The eighth chapter by-laws 61st these measures come into force on March 1, 2013.