Ningxia Hui Autonomous Region, Medical Approaches

Original Language Title: 宁夏回族自治区医疗救助办法

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  Chapter I General provisions article in order to standardize and strengthen the medical relief work, according to the State Department and other provisions of the interim measures for the social assistance, these measures are formulated.

Article II medical relief in these measures refers to meet the conditions of residents in difficulty, in accordance to the modalities, procedures and criteria, fee subsidies for basic medical insurance for urban and rural residents and the medical cost assistance system.

Medical aid should follow article hold the bottom line, and convergence, the principle of open, fair, efficient and convenient.

Fourth specific administration of the Home Department is responsible for medical assistance.

Human resources and Social Security Department is responsible for the basic medical insurance, major medical insurance system and medical assistance system interface.

Health and family planning departments are responsible for supervision of the designated medical services medical services management, medical aid with civil affairs departments and make "one-stop" real time work.

Financial sector, auditing organs responsible for supervising the medical relief fund.

Fifth to encourage social forces medical aid for residents in difficulty.

Chapter two bailouts sixth household the following residents of the autonomous region, you can apply for medical assistance: (a) special hardship case dependent persons; (b) subsistence; (c) orphans; (d) elderly low-income older persons; (e) low-income families seriously disabled persons; (vi) key entitled groups; (VII) poor families ill personnel due to illness.

Seventh article has following case one of of, not rescue: (a) for crime, and suicide, and self-mutilation, and fight fights, and alcohol, and drug, occurred of medical costs; (ii) for traffic accident, and medical accident, accident occurred of medical costs; (three) for veneers, and cosmetic, and orthopaedic, and distribution mirror, occurred of costs; (four) for married Qian check, and health, and purchase tonic, and nutrition, occurred of costs; (five) for using basic medical insurance directory yiwai of drug, and medical with supplies and at their own expense clinic project produced of costs;

(Six) forged, and altered related ticket of; (seven) has statutory maintenance, and raised, and dependency obligations people, and statutory maintenance, and raised, and dependency obligations people has capacity bear its medical costs of; (eight) medical rescue applicants I and common life of family members name has two sets above housing of (for demolition or shantytown transformation, compensation of placed room, and economic applies housing except);

(I) medical aid applicants and their family members have lives to live together with motor vehicles (disabled for functional compensation of masses of motor vehicles and ordinary except for two-wheeled motorcycles) and other non-necessities of high-end consumer goods.

Chapter III aid and standard eighth medical help urban and rural residents to take basic medical insurance subsidy, outpatient illness assistance, hospitalization subsidies and major diseases grants and other means.

Nineth special hardship case dependent workers, subsistence, orphans, elderly low-income seniors and low-income families, severe disability and key entitled groups participating in basic medical insurance for urban and rural residents, their domicile County (municipal and district), civil affairs departments should give subsidies to their personal contributions.   

Tenth Article SHC dependent personnel, and minimum life guarantees object, and orphans, and senior low-income elderly in autonomous regions within Sentinel medical institutions treatment outpatient big disease, in deduction various medical insurance paid part and non-Medicare drug price Hou, on remaining costs according to following standard give grants: (a) SHC dependent personnel and orphans give 90% grants, per person annual cumulative not over 3,000 yuan; (ii) minimum life guarantees object, and senior low-income elderly give 50% of grants, per person annual cumulative not over 2000 Yuan.

11th article SHC dependent personnel, and minimum life guarantees object, and orphans, and senior low-income elderly, and low-income family heavy degrees disabled and focus special care and object in autonomous regions within Sentinel medical institutions hospital treatment of, hospital total costs in deduction various medical insurance paid part, and focus special care and medical grants claims part and non-Medicare drug price Hou, on remaining costs according to following standard give grants, per person annual cumulative not over 30,000 Yuan: (a) SHC dependent personnel and orphans give 90% grants;                                                                                                                                              

(B) subsistence and low-income families, disabled persons, elderly low-income elderly and key entitled groups give a grant of 70%. 12th article this approach sixth article provides of rescue object with heavy King disease, years hospital total costs cumulative over annual family can dominated income of, in deduction various medical insurance paid part, and home medical rescue part and non-Medicare drug price Hou, on remaining costs according to following standard give grants, per person annual rescue once, highest grants amount not over 80,000 Yuan: (a) remaining costs in 30,000 yuan to 100,000 yuan of, give 50% of grants; (ii) remaining costs in 100,000 yuan above of (containing this number),

60% allowances shall be provided.

13th single hospital Medicaid settlement, not limited to residential number.

Rescue object hospital treatment not reached urban and rural residents big disease medical insurance paid conditions of, deduction various medical insurance paid part and non-Medicare drug price Hou, by home sector directly give rescue; on reached urban and rural residents big disease medical insurance conditions of, should by big disease insurance handling institutions settlement Hou, deduction various medical insurance paid part and non-Medicare drug price Hou, by home sector give rescue.

14th bailouts did not participate in the urban and rural residents of basic medical insurance or workers ' basic medical insurance to apply for medical assistance, in accordance with 10% of the total medical expenses subsidies, aid per person per year, the highest amount of subsidy does not exceed 80,000.

          15th medical aid standards based on levels of economic and social development should be adjusted, adjusted standards drawn up by the Home Department in financial departments of the autonomous region, autonomous region people's Government for approval before implementation.

Chapter fourth aid program 16th to aid subsidies objects participating in basic medical insurance for urban and rural residents, the County (city, district) Civil Affairs Department on an annual basis to the financial sector and medical insurance agency register of subsidies and subsidies, financial sector assessment, funding criteria from the medical fund allocated.

17th article SHC dependent personnel, and minimum life guarantees object, and orphans and senior low-income elderly application outpatient big disease medical rescue, or for illness need in non-Sentinel medical institutions hospital treatment application medical rescue of, by its I or family to household location County (city, and district) home sector proposed application, and submitted following application material: (a) residents booklet, and I ID; (ii) SHC personnel dependent (five) card, and low guarantee, and children welfare card, and senior low-income elderly basic life allowance card;

(C) proof of medical certificate of diagnosis, hospitalization expenses statement (iv) rural and urban resident basic medical insurance, medical insurance, commercial insurance settlement of urban and rural residents.

18th article low-income family heavy degrees disabled, and focus special care and object, and for disease to poverty family sick personnel hospital treatment application medical rescue of, should to household location Township government, and subdistrict offices proposed, and submitted following application material: (a) residents booklet, and I ID; (ii) disability card, and special care and card; (three) medical institutions issued of diagnosis proved, and hospital costs settlement single; (four) urban and rural residents basic medical insurance, and urban and rural residents big disease medical insurance and commercial insurance, insurance settlement single. 

The Township people's Governments, neighborhood offices shall, within five working days as of receipt of the application materials for applicants status and family research, review the income and property status; audited in accordance with the conditions, in conformity with the conditions of the certificate, submitted to County (municipal and district) Civil Affairs Department for approval.

The 19th counties (cities and districts) Home Department shall within five working days as of receipt of the application materials are reviewed.

The County (city, district) departments of Civil Affairs agreed to aid, shall, within five working days after the decision to bailout funds directly into the rescued person through a bank account does not agree to aid shall, within two working days of the decision, notify the applicant or his agent, and explain the reasons.

20th article SHC dependent personnel, and minimum life guarantees object, and orphans, and senior low-income elderly in household location Sentinel medical institutions hospital treatment application medical rescue of, should in handle discharged settlement procedures Shi to Sentinel medical institutions "a station type" service window proposed application, and submitted following material: (a) residents booklet, and I ID; (ii) low guarantee, and SHC personnel dependent (five) card, and children welfare card, and senior low-income elderly basic life allowance card.

Designated medical institutions to comply with the conditions shall be in accordance with the provisions of the assistance standard advance medical assistance funds.

21st counties (cities, districts) civil affairs departments should set up Exchange account with designated medical institution information management system.

For larger Medicaid expenditures, advances from the designated medical institutions difficult, the civil affairs departments can contribute to the designated medical institutions advance a certain amount of medical expenses through bank transfer into the treatment of designated medical institutions.

22nd medical aid costs on an annual settlement, medical expenses for the fourth quarter last year, can be settled in the first quarter of the following year. Fifth chapter Fund financing and management of the 23rd people's Governments above the county level to establish medical fund.

Medical Rescue Fund source including: (a) Central and autonomous regions financial grants of urban and rural medical rescue funds; (ii) set district of city, and County (city, and district) according to when by needed of urban and rural medical rescue funds arrangements of this level financial funds; (three) from autonomous regions welfare Lottery chest in the arrangements of funds; (four) social donor of funds; (five) Fund formed of interest income. 

24th medical relief fund should be included in the accounts of the Social Security Fund, the implementation of special accounts accounts, earmarking, unified mobilization, unity.

The financial sector should be established in the accounts of the social security fund "medical relief fund account", for handling the collection of funds, appropriated, payment and other business, and in accordance with civil affairs departments at the same level with plan approval and disbursement.

No unit or individual is allowed to extract from the Fund management fees or expenses other expenses. 25th medical relief fund should be balanced, slightly balances.

The County (city, district) medical relief fund during the year accumulated total balance does not exceed the year raising money for 15%, used balance carried forward to the next year; balance exceeds 15%, State finances can be appropriate to reduce the allocation of relief funds.

26th the County (city, district) the Department shall, in conjunction with the Ministry of Finance announced a bailout funds used each year and list objects of medical aid and the aid amount, subject to public supervision.

The sixth chapter services and supervision article 27th Home Department shall, in conjunction with human resources and Social Security Department, establishment of urban and rural residents, urban and rural residents of basic medical insurance major medical insurance, commercial insurance, emergency medical relief connecting the Medicaid clearing system, and gradually realize the synchronization at designated medical institutions settled rural and urban basic medical insurance, Medicare and Medicaid costs of urban and rural residents.

28th medical service institutions should strengthen medical aid, "one-stop" service Windows Management, according to the provisions of audit, diagnosis, treatment, settlement procedures.

Designated medical institutions shall, in accordance with the basic medical insurance three directories, list of medical insurance for urban and rural residents as well as disease-specific limit requirements, providing clinical services for help in a timely manner; use a directory other than medicines, medical supplies, and diagnosis and treatment projects at their own expense, you should indicate the drugs at their own expense, and signed by the bailouts and their family members.

29th civil affairs departments shall, jointly with the Department of health and family planning, human resources and social security, designated medical institutions on a regular basis, "one-stop" service window check, diagnosis, results of conducting supervision and inspection, found to be in conformity with the provisions and should be corrected in a timely manner.



30th to apply for Medicaid staff shall provide relevant documents, not fraud, may not obtain medical assistance.

Seventh chapter legal responsibility 31st article violation this approach provides, home, and financial, sector and staff, has following case one of of, by superior administrative organ or monitored organ ordered corrected; on directly is responsible for of competent personnel and other directly responsibility personnel law give disposition: (a) on meet application conditions of rescue application not accepted or not approved of; (ii) on not meet rescue conditions of rescue application be approved of; (three) leaked in work in the knows of citizens personal information, caused bad consequences of;

(D) loss, tampering, receiving social relief funds and goods, service records and other data, and (v) not in accordance with the provisions in bailout funds or provide related services; (vi) medical assistance system in the performance of duties in the course of other abuse their powers, neglect their duties, engages in behavior.

32nd article violates these rules, civil affairs, finance, and other departments and their staff retention, squeeze, misappropriating, privately divide Medicaid funding, be ordered by the authorities to recover; has illegally obtained, confiscation of illegal income; directly responsible in charge and other direct liable persons shall be given administrative sanctions.

The 33rd article violates these rules, designated medical institutions not complying with the provisions of audit, diagnosis, treatment, settlement procedures, by the relevant Department in charge shall command a correction in serious cases, appointed medical institutions of their qualifications beyond medical assistance Medicaid funds settled the policy, by the medical institution.

The 34th article violates these rules, save the object fraud, concealment, false means to defraud Medicaid funding by the Home Department decided to stop aid, ordered to return bailout funds obtained illegally, unlawfully obtained relief 1 time more than three times the amount of a fine.

35th of the eighth chapter, schedule the following terms shall have the meanings herein: (a) special hardship case dependent people, refers to a life without work, without sources and without legal support, maintenance, maintenance obligations, persons, or its legal support, maintenance, maintenance obligations, no maintenance, upbringing, the ability of the elderly, persons with disabilities.

(B) subsistence object refers to the residents enjoy the benefits of minimum life guarantee.

(C) orphans, is recognized by the civil affairs departments lost parents, not find birth parents of minors under 18 years of age or under 18 years of age and one parent has died, the other disappearances, remarried or is serving a sentence, such as lead, in fact no one dependent minors.

(D) elderly low-income seniors, enjoy civil administration payment of old age income refers to old-age benefits for low-income seniors.

(E) low-income families seriously disabled persons, refers to the monthly per capita income of less than the local minimum living standard 150% to low-income families for more than two (ii) seriously disabled persons. (Six) focus special care and object, is refers to has autonomous regions urban and rural residents household, and in autonomous regions range within received regularly pension or regularly quantitative grants of has exit active of disability soldiers, and in Xiang demobilized soldiers, and sick home veterans, and in Xiang retired old reds soldiers (containing in Xiang West Road reds soldiers, and reds separated personnel), and martyrs survivors, and for public sacrifice soldiers survivors, and died soldiers survivors, and war involved nuclear retired personnel, and 60 age above rural nationality retired soldiers, and

Over 60 years old children of martyrs (before the founding of the wrong kill rehabilitate children), retired Army personnel directly involved in uranium mining.

(G) poverty caused by disease family sick personnel, refers to the risk of serious disease, the annual total hospitalization costs exceeded annual disposable household income and deductions of medical insurance to pay for part, part home medical assistance and non-Medicare drug price, amounted to more than 30,000 personnel remaining.

(H) outpatient disease refers to the basis of basic medical insurance for urban and rural residents of the autonomous region disease and identify illnesses.

(I) the various types of health insurance, refers to the urban and rural residents of basic medical insurance, urban and rural residents in medical insurance, basic medical insurance, employee's large medical benefits, supplementary medical insurance, medical insurance and other insurance.

(J) medical aid, "one-stop" real time refers to meet the conditions for medical aid rescue at designated medical institutions medical, hospital settle medical expenses at the same time, basic medical insurance for urban and rural residents to enjoy compensation and settlement system of the home departments of medical relief assistance.

Article 36th bailouts paid by the single disease serious disease hospitalization, the cost of hospitalization in State policy to give medical assistance, not subject to aid as provided herein and the maximum year cumulative aid restrictions.

37th districts municipalities and counties (cities, districts) can be according to the level of local economic and social development and the financial income and expenses, set above the relief standard as provided herein. 38th article of the measures shall take effect on December 1, 2015. November 19, 2009, published by the Office of the autonomous regional people's Government of the Ningxia Hui autonomous region, urban medical rescue procedures (trial implementation) and the Ningxia Hui autonomous region, the rural medical assistant (trial) (better governance (2009), No. 242) repealed simultaneously.

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