Administrative measures for the new rural cooperative medical system in Harbin
(March 17, 2011 Harbin municipal people's Government at the 78th Executive Meeting March 28, 2011 Harbin municipal people's Government order No. 228, released as of May 1, 2011) Chapter I General provisions
First in order to strengthen the management of new-style rural cooperative medical care, improve the level of rural residents ' health security, promoting social stability, according to the relevant provisions of national and provincial, combined with the city's actual, these measures are formulated.
Article within the administrative area of the city of new rural cooperative medical management and supervision, these measures shall apply.
Article new rural cooperative medical care in these measures (hereinafter referred to as the new type of rural cooperative), which is run by a Government Organization, guidance, support, rural residents volunteered, personal, corporate and Government funding, establishing the basic medical insurance system for rural residents.
Article IV of the new rural cooperative system adhere to the wide coverage, the basic principles of, sustainable, be commensurate with the level of economic and social development.
Fifth of municipal, district and County (City) Government ncms should be incorporated into the national economic and social development planning, strengthen the Organization, coordination and leadership.
Sixth is the municipal public health Administrative Department of the city of ncms work departments, responsible for organization and implementation of the measures.
District and County (City) public health Administrative Department is responsible for the area in new rural cooperative medical management.
The township (town) people's Government (Street), the village (neighborhood) Committee shall take ncms mobilization, propaganda, and so on.
Development and reform, finance, audit, administration, human resources and social security, agriculture, the food and drug administration, disabled persons ' Federation and other relevant departments and units shall, in accordance with their respective responsibilities, the new type of rural cooperative work.
Seventh of municipal, district and County (City) health administrative departments to the new type of rural cooperative agency in accordance with this regulation, is responsible for insurance eligibility, medical audit, supervision, inspection assessment and so on.
Eight new rural cooperative implementation of territorial management, areas, counties (cities) for the overall planning and progressive, integrated in the urban area.
Chapter II participants
Article Nineth all the city residents living in rural areas (hereinafter "rural dwellers"), can be based on the family unit as provided herein to participate in domicile or habitual residence of ncms.
States and provinces to participate in the new rural cooperative medical personnel (hereinafter "the participating personnel") entitled other provisions from its provisions.
Article tenth of participating officers are permitted to participate, basic medical insurance for urban residents, or repeat the ncms.
11th participation registration personnel should be based on the family unit, certification for participating in new rural cooperative (cards), card (card) medical treatment and enjoyment of new rural cooperative medical treatment.
12th participating personnel shall enjoy the following rights:
(A) enjoy claims compensation under treatment;
(B) co-ordinate appointed medical institutions of their choice within the region;
(C) free access to treatment, medical services and fees;
(D) free query, check individual payment and receive treatment records;
(E) management and use of the new type of rural cooperative funds;
(Vi) made comments and suggestions on the new type of rural cooperative work.
Rural residents in 13th annual participation in the new rural cooperative and enjoy when the new rural cooperative medical treatment.
Article 14th participation shall perform the following obligations:
(A) in households paid to participate in the new rural cooperative medical costs;
(B) provide truthful personal information;
(C) when will not be out of the new type of rural cooperative;
(D) comply with the ncms other relevant regulations.
Chapter III fees and subsidies
15th new IICA to implement individual contributions, combining collective support and Government subsidies.
Encourage citizens, legal persons and other organizations to contribute to the new type of rural cooperative funds.
16th rural residents should be the domicile, habitual residence, the village (neighborhood) committees or townships (towns) to finance the costs of paying family members to participate in the new rural cooperative.
Rural poor families in 17th member, wubaohu, key entitled groups and severe disability, eligible poor people with disabilities and other special persons who have difficulty in participating in new rural cooperative, their personal contributions to the Government-funded.
Article 18th rural residents taking part in the new rural cooperative medical fees imposed in advance on an annual basis, every year from September 1 to December 20 for paid next year to participate in the new rural cooperative medical costs.
Payment time needs to be adjusted, approval of the Administrative Department of public health reported to the people's Government at the release to the community.
19th levels of government financial assistance fund, endowments and funds in accordance with the provisions of the time and procedures.
20th rural residents taking part in the new rural cooperative medical costs by household and Government commitment and funding criteria in accordance with the relevant provisions of the State and province.
Article 21st of township (town) should be issued to participating personnel uniformly across the province by the financial funds of special receipts.
The fourth chapter of the new type of rural cooperative treatment
22nd rural residents who participate in the new rural cooperative medical procedures and pay next year to participate in the new rural cooperative medical costs, payment from January 1 to December 31 next year to enjoy the new rural cooperative medical treatment.
23rd participating staff in the outpatient and inpatient medical costs reimbursed by the new rural cooperative medical Fund for compensation in accordance with regulations.
Article 24th participating in outpatient and inpatient treatment, implementation of the national and provincial drug directories, medical items and health services standards requirements.
25th appointed medical institutions of participating in the inpatient medical costs, payment lines according to the following standards:
(A) in township hospital, pay line is no more than 100 Yuan;
(B) in district and County (City) level-I hospital, payment not higher than 300;
(C) at the provincial and municipal hospitals, payment is no more than 500 Yuan.
Article 26th appointed medical institutions of participating personnel in hospital medical expenses, beyond the part above the payment standard, in line with the policy coverage, payment of hospitalization expenses in accordance with the national and provincial reimbursement.
27th participating personnel in a natural during the year maximum reimbursement limit for medical expenses should be achieved in the previous year the overall per capita annual net income of rural residents of more than 6 times, and is not less than 50,000 yuan.
In accordance with the highest limit after the reimbursement, which now covers personnel still find it difficult to afford health care and medical relief, in accordance with the relevant provisions of medical aid.
28th article members of poor families in rural areas, wubaohu, key entitled groups and seriously disabled persons, in line with conditions of poverty of persons with disabilities, and other special people in hospital, and Manpower can be appropriately increased hospital reimbursement 3%-5%, reduce or cancel the payment.
Article 29th of participating personnel in new rural cooperative medical card (card) in the integrated region provides outpatient medical expenses for the designated medical institutions, medical institutions directly handle reimbursement procedures, designated medical institutions to advance the reimbursement of expenses.
30th the following situation and meet the requirements of new rural cooperative medical reimbursement, inpatient medical advances made from the participating individual, after the end of treatment, related materials, to the seat of participating the new rural cooperative agency for the reimbursement procedures:
(A) other than participating in the co-ordination area (excluding offshore) workers, family visits, tourism, disease, and inform and manpower in the 5th after admission area new rural cooperative agencies;
(B) the condition other than medical treatment needed to co-ordinate areas of hospitals.
Personal expenses prescribed in the preceding paragraph of this article and the reimbursement rate with reference to local standard reimbursement of medical institutions at the same level.
31st overall area shall, in accordance with changes in funding levels, timely adjustment of new rural cooperative medical reimbursement policy, upon approval by the people's Governments at the same level, to the public.
The integrated area should guide and encourage participation in personnel at the grass-roots medical institutions for treatment, inpatient reimbursement rate increase in grass-roots medical institutions.
The pooling area shall be in accordance with the relevant provisions of national and provincial, on the use of Chinese medicine in the treatment of participating personnel appropriate to reduce the payment line and increase the proportion of claims.
Article 32nd overall area shall, in accordance with national and provincial scope of chronic diseases under actual determine the local chronic disease to be reimbursed, and claims payment, reimbursement and maximum limit.
Confirmed by contracted medical institutions and patients with chronic disease confirmed by the agencies handling the new type of rural cooperative, by co-ordinating the requirements for medical treatment and for reimbursement procedures.
Article 33rd participating staff in district and County (municipality) and township (town) fixed rates with medical institutions in medical expenses.
Participation in municipal medical institutions of health care personnel with progressive introduction of instant knot.
Article 34th participating officers implemented instant knot fixed-point medical institutions of medical costs, reimbursement formalities shall discharge the end of treatment, receive reimbursement of compensation payments.
Participating in the other provinces, municipalities or not implemented immediately appointed medical institutions of nodal reporting medical costs, new rural cooperative medical agencies shall submit all the materials completing reimbursement within 30 working days of compensation procedures.
Article 35th of participating personnel of the reimbursement of medical expenses should be provided with ID card, residence booklet, to participate in the new rural cooperative medical card (card), hospital medical records, medical expense listing, referral certification, medical expense receipts for reimbursement.
36th medical expenses not included in the new rural cooperative medical Fund for reimbursement of the following ranges:
(A) cosmetic and beauty as a result of assault, suicide, self-harm, drug and alcohol abuse and other medical expenses for the injury caused;
(B) the laws and regulations should be borne by the victim's medical expenses;
(C) according to the provisions of the medical fees paid by workers ' compensation and maternity insurance fund;
(D) do not belong to the new type of rural cooperative medical care medication list and medical service the medical costs of the project;
(E) other provisions do not conform to the new type of rural cooperative medical reimbursement costs.
37th participating personnel shall not be any of the following acts:
(A) would participate in the new rural cooperative medical card (card) lent others compensation for medical reimbursement or obtaining a new type of rural cooperative funds;
(B) forging, altering medical expense receipts, medical records, or the purchase or use of false medical expense receipts, medical records, ncms fraudulently claim compensation funds;
(C), inspired, and collusion with the medical staff, or other fraud, ncms fraudulently claim compensation funds;
(D) other acts that violate the provisions of the new type of rural cooperative.
The fifth chapter funds management
38th new rural cooperative medical fund include:
(A) the fees for rural residents;
(B) at all levels of government financial assistance fund;
(C) the funding of the rural collective economic organizations;
(D) social donation funds;
(V) interest on new rural cooperative medical fund;
(F) the laws and regulations of other income.
39th new rural cooperative medical fund categories and the percentage of funds determined according to the relevant regulations of the State and province.
40th integrated financial departments shall, in accordance with relevant regulations of the State, the local State-owned or State-controlled commercial banks opened special accounts for new rural cooperative medical fund.
41st new rural CMS funds management account store, earmarked, in order to support, balance, the principle of balance, slightly closed operation.
42nd overall area shall, in accordance with national and provincial regulations, establish a sound financial system and accounting system for the Fund, strengthening the Fund management to ensure safe operation.
Article 43rd of the new rural cooperative medical fund accounts payment system, in accordance with the following procedures shall be followed:
(A) pooling area new rural cooperative agency audit insurance reimbursement fee, fill in the new rural cooperative medical outpatient reimbursement payment vouchers and the new rural cooperative medical in-patient medical expenses reimbursement of payment documents, peer review of the financial sector.
(Ii) sibling financial sector review Hou, through new agricultural collection Fund designed households, will Sentinel medical institutions first advance of claims costs, allocated to Sentinel medical institutions, will participating personnel personal advance of claims costs, allocated to district, and County (City) or Xiang (town) new agricultural collection handling institutions, district, and County (City) or Xiang (town) new agricultural collection handling institutions should timely notification participating personnel received.
44th new rural cooperative medical agencies shall promptly with designated medical institutions settled by the advance of medical expenses.
Article 45th co-ordination should establish new agricultural information management system, implementation of new rural cooperative information management.
Article 46th people's Governments at all levels have made outstanding contributions to new rural cooperative sector, gives awards to units and personnel.
The sixth chapter designated medical institutions 47th article of the new rural cooperative medical system of hospitals.
Designated medical institutions by health administration departments at or above the county level in selected medical institutions, list of designated medical institutions shall be announced to the public.
Designated medical institutions designated qualification, validation standards and assessment methods, and integrated regional health authority under these rules shall be separately formulated and approved by the people's Governments at the same level to the public.
48th of municipal, district and County (City) of new rural cooperative medical agencies shall, in accordance with management needs, signed a service agreement with designated medical institutions, specify the rights and obligations of both parties.
Designated medical institutions should provide reasonable and necessary medical services for the participating personnel, protecting the legitimate rights and interests of participating personnel.
49th designated medical institutions shall be subject to the new type of rural cooperative agency business guidance and supervision, and shall perform the following duties:
(A) timely diagnosis and treatment of patients;
(B) verification visits ncms the patient's true identity to prevent impersonation;
(C) for ncms provides health education, the new type of rural cooperative project question answering services such as policy advice, diagnosis and treatment;
(D) determine the specialized agencies and personnel responsible for the costs of new rural cooperative medical audit and settlement;
(E) comply with the new rural cooperative medical management requirements.
50th designated medical institutions shall implement the administrative departments of public health promulgated by ncms basic medication list and treatment project directory, ncms patients admitted in the hospital under a hospital standards, insist on reasonable inspection, rational drug use, treatment, and reasonable fees.
Because of conditions beyond the essential drug list drugs at their own expense, or list of projects beyond the diagnosis and treatment of examination or treatment at their own expense, should have consent of the new rural cooperative medical patients and their family members and to sign it.
Designated medical institutions are encouraged to use Chinese medicine to treat new patients.
51st medical institutions should standardize drug procurement program, establish and implement a drug stock checking system shall purchase and use does not comply with prescribed drugs.
52nd medical institutions should strictly implement the State and provinces to develop standards in medical technology and procedures, strengthen infrastructure construction and personnel training, improve service quality, ensure safety.
53rd should publicity of new rural cooperative medical institutions fees and pricing, coverage, reimbursement and compensation conditions and procedures, except as personal.
54th designated medical institutions and medical personnel should improve medical service quality and level of service, prohibit any of the following acts:
(A) of the participating personnel costs included in the scope of new rural cooperative medical fund;
(B) the new type of rural cooperative fees paid is not included in the scope of new rural cooperative medical fund;
(C) exceed the ncms needs to check the patient's condition, medication, treatment;
(D) unauthorized raising fees, fee increase;
(E) fraud take ncms claim compensation funds;
(Vi) other acts that violate the provisions of the new type of rural cooperative.
The seventh chapter monitor
55th appointed medical institutions of health administrative departments shall establish and perfect evaluation system, strengthen the supervision and management of designated medical institutions.
56th city and the overall area is followed by representatives of the relevant departments of the Government, deputies, CPPCC members and participating staff representatives and experts of new rural cooperative medical Oversight Committee to strengthen the new rural cooperative medical Fund, appointed medical institutions of management and service quality of supervision.
57th no organization or individual has the right to violate the provisions of the new rural cooperative medical management reports, complaints.
Levels health administrative sector, and new agricultural collection handling institutions and financial, and audit sector should established sound complaints reported system, to social announced reported complaints phone, on belongs to this sector, and this institutions duties range of complaints, and reported, should timely verified, and processing, and replies; on not belongs to this sector, and this institutions duties range of complaints, and reported, should timely told party or to right to processing of sector, and institutions processing.
58th levels of health and financial departments should strengthen the supervision of the new rural cooperative medical fund.
Audit departments at all levels shall strengthen the special audit of the new rural cooperative medical fund.
59th levels of new rural cooperative medical agencies should regularly to the people's Government at the and the new type of rural cooperative Oversight Committee report and report on the new rural cooperative medical fund payments and the use of, and accept their supervision.
60th levels the new IICA agencies participating on a regular basis of the inpatient and outpatient integrated medical expenses compensation for public notification, ensure participation in people's right to know, to participate and to supervise.
61st in the new IICA administration shall not be any of the following acts:
(A) corruption, misuse, misappropriation, interception, concealing the new type of rural cooperative funds;
(B) the scope of the non-reimbursed medical expenses include compensation of participating personnel;
(Iii) deducted or are not paid on time the new type of rural cooperative funds;
(D) the lost or altered, payment records, obtain the new rural cooperative medical treatment records;
(E) falsified, fabricated or intentionally destroying the books and materials;
(Vi) favoritism, bribes;
(G) violations of new rural cooperative medical management, resulting in loss of funds;
(VIII) other acts that violate the provisions of the new rural cooperative medical management.
The eighth chapter legal liability
62nd designated medical institutions for the fraud, forgery proof ncms fraudulently claim compensation funds or other means, by the health Administrative Department in charge shall command returned to defraud funds fined 5,000 yuan and 30,000 yuan fine, and cancel the designated medical institutions eligible directly in charge of personnel and other persons in accordance with relevant laws and regulations.
Fixed-point medical institutions of service agreement violations, are handled by the health Administrative Department under the service agreement.
63rd participating persons to fraud, forgery proof ncms fraudulently claim compensation funds or other means, the public health Administrative Department in charge shall command returned to defraud funds, impose a penalty of 200 Yuan more than 1000; refusing to return or pay the fines, cancellation of his family that year enjoy the qualification of new rural cooperative medical treatment constitutes a crime, transferred to the judicial organs according to law.
64th new rural cooperative agency staff member violated these measures 61st article, the public health Administrative Department shall be ordered to correct, in accordance with management permissions to administrative sanctions; losses caused to a new rural cooperative medical fund or individual shall bear liability constitutes a crime, judicial organs according to law.
65th State personnel in the new type of rural cooperative management and supervision in abuse of power, dereliction of duty or engages in, directly in charge of personnel and other persons in accordance with the management of permission shall be given sanctions constitutes a crime, judicial organs according to law.
66th participating officials believe that the new rural cooperative medical management authority or violation of their legitimate rights and interests of the authority, may apply for administrative reconsideration or bring an administrative suit.
Nineth chapter by-laws
67th living to the city's rural residents in other provinces, municipalities, may, in accordance with the rules to participate in the new rural cooperative.
68th and manpower areas in accordance with national, provincial and formulated detailed rules for the implementation of the present measures, reported to people's Governments at the same level for approval to the public.
69th State and province new rural cooperative payment period, payment and subsidies, reimbursement and maximum limit of other provisions, such as, from its provisions. 70th these measures come into force on May 1, 2011. The Harbin municipal people's Government promulgated on May 25, 1998, rural cooperation medical policy (Government Decree 6th) repealed simultaneously.