Administrative Measures For The Agricultural And Pastoral Areas In Tibet Autonomous Region Medical

Original Language Title: 西藏自治区农牧区医疗管理办法

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Administrative measures for the agricultural and pastoral areas in Tibet Autonomous Region medical

    (November 1, 2012, the Tibet Autonomous Region people's Government, the 19th General Meeting November 26, 2012, the Tibet Autonomous Region people's Government promulgated as of January 1, 2013, 116th) Chapter I General provisions

    The first agricultural and pastoral areas to improve the health care system, improve the level of medical insurance for farmers and herdsmen, according to relevant regulations of the State and the autonomous communities, combined with State practice, these measures are formulated.

    Second residence in the autonomous region within the administrative area of medical care, claims compensation for medical expenses of farmers and herdsmen in agricultural and pastoral areas and medical funds, management and supervision of the application of this approach has been used.

    Third agricultural and pastoral areas health care system is Government-led, based on the free medical care, the Government, the collective, the individual and society to raise funds, carry out serious illness, outpatient family accounts and medical venture fund with a combination of basic medical insurance system for farmers and herdsmen.

    The fourth agricultural and pastoral areas health care system adhere to the voluntary payment and fair principle of Huimin and ensure an appropriate degree of enjoyment and convenience.

    Five Governments at all levels should establish agricultural and pastoral areas and improve the medical system into local economic and social development plans, as an important part of establishing social security system in agricultural and pastoral areas, and constantly improve the farmer supplementary business insurance mechanism.

    Sixth article County above Government should strengthening agricultural and pastoral areas grass-roots medical health institutions construction and talent training, improve health service level, guarantees grass-roots health personnel treatment; strengthening agricultural and pastoral areas medical information construction, formed medical management handling institutions, and Sentinel medical institutions and about sector Zhijian interconnected exchange of medical management information system, in gradually promotion farmers and herdsmen medical "a cartoon" of based Shang achieved agricultural and pastoral areas medical Fund claims compensation costs offsite rates settlement.

    Chapter II Organization and administration Seventh autonomous region, Prefecture (City) was established by the health part, finance, Office, human resources and social security, development and reform, civil affairs, auditing, monitoring, publicity, radio, film and television, education, agriculture, poverty alleviation, food and drug administration, the population and family planning CDPF sectors, women's federations, of medical coordination leading group responsible for organizing the agricultural and pastoral areas, inspection, guidance and coordination of medical work.

    Its day-to-day management by the autonomous region, Prefecture (City) health Administrative Department is responsible for.

    The eighth County (city, district) and township (town) people's Government was established consisting of representatives from relevant government departments and farmers and herdsmen in agricultural and pastoral area medical Management Committee (hereinafter referred to as the HA), responsible for the coordination, management and supervision of agricultural and pastoral areas of medical work. Nineth counties (cities, districts) of health administrative departments and township (town) people in agricultural and pastoral area medical management agencies are responsible for specific tasks.

    Medical management agency personnel and funding included in the budget at the same level shall not be extracted from the medical fund.

    The tenth County (municipal and district) in agricultural and pastoral area medical management responsibilities of the Agency:

    (A) promote agricultural and pastoral areas health policy, (ii) in accordance with the measures to develop, work systems and processes and organize the implementation of the programme of work;

    (C) the organization raise medical funds; (d) the administrative counties (cities and districts) in agricultural and pastoral area medical funds;

    (E) the issuance of medical certificates;

    (F) in accordance with the regulations in full reimbursement of medical expenses in a timely manner;

    (G) collecting, collating, analysis of agricultural and pastoral areas and reported to medical management and operation and other relevant circumstances;

    (VIII) responsible for the farmers and herdsmen's supplementary medical insurance-related data collection and reporting;

    (I) meet the medical conditions of farmers and herdsmen with medical expenses credential or certificate;

    (J) the monitoring, inspection and evaluation of township (town) medical management agencies;

    (11) the higher levels of Government as well as other relevant departments to arrange agricultural and pastoral areas of medical management.

    11th townships (towns) in agricultural and pastoral area medical management responsibilities of the Agency:

    (A) promote agricultural and pastoral areas health policy;

    (B) organize the implementation of County (city, district) medical management agencies to develop work programmes, work systems;

    (C) to mobilize Township (town) on financing for farmers and herdsmen to participate in medical, and is responsible for the registration and certification of work;

    (D) is responsible for raising private pay cost of farmers and herdsmen and turned in on time (city, district) medical management agencies;

    (E) management outpatient families of farmers and herdsmen account funds;

    (F) the township (town) in township hospitals and village clinics to supervise the quality and cost of health services management, and urge them to continue to improve conditions of service, improve the capacity, level of service and quality;

    (VII) is responsible for the medical reimbursement of compensation of farmers and herdsmen is publicly available;

    (VIII) is responsible for the township (town), outpatient, hospital expense claims of statistical report of peasants and herdsmen;

    (I) the County (city, district) people's Governments and their departments and County (city, district) or other work assigned by management agencies.

    Chapter III medical facility management

    12th pastoral area medical funds gradually carry out prefectural (City) level overall, end provincial co-ordination.

    13th the main source of agricultural and pastoral area medical funds include:

    (A) the national free health special funding arrangements and new cooperative medical assistance;

    (B) autonomous region, Prefecture (City) and County (city, district) Government financial arrangements for free medical and special funds;

    (C) the person pay voluntary annual funding;

    (D) the County (city, district) district administrative departments to of generations of farmers and herdsmen eligible for Medicaid personal financing;

    (E) enterprises, institutions, social organizations and individual donors;

    (Vi) interest income arising from agricultural and pastoral area medical funds;

    (VII) other sources.

    14th personal financing for voluntary payment, based on the family unit in the time allotted to the township (town) or medical management agencies commissioned by the village Committee individual funding, administered by the medical agency or door-to-door registration by people of the village Committee, reported to County (municipal and district) medical management agency approval, issued by the accounts of family medicine.

    Birth year, parents automatically enjoy agricultural and pastoral areas health policy, may, as from the second year by voluntary individual financing.

    Meet the conditions for medical assistance, personal contributions by the County (city, district) departments of district administration.

    Of the family medical account uniformly printed by the State Administrative Department of public health. 15th family relocation of peasants and herdsmen, healthcare relationship go to move to County (municipal and district) medical management agencies.

    Families of farmers and herdsmen to non-agriculture, their family account fund balance by the township (town) medical management agencies be refunded. 16th medical fund agricultural and pastoral areas are divided into catastrophic Fund, outpatient family account and medical venture fund categories.

    The ratios and the use of which is: (A) serious illness Fund.

    Heads of the total Fund for agricultural and pastoral areas account for medical, for farmers and herdsmen hospital medical expenses and compensation for special diseases outpatient reimbursement. (B) outpatient family Fund.

    Agricultural and pastoral areas account for medical 28-38% of the total amount of the Fund used for outpatient medical and health costs of claims compensation of farmers and herdsmen.

    On by autonomous regions policy provides standard voluntary pay personal funding of farmers and herdsmen family, from the households agricultural and pastoral areas medical Fund total in the by 28-38% designated into its outpatient family account, personal funding over autonomous regions policy provides standard of, beyond part full designated into its outpatient family account; on not pay personal funding of farmers and herdsmen, only extraction the households agricultural and pastoral areas medical fund source in the free medical special funding and cooperation medical grants funding two items total of 28-38%, designated into its outpatient family account. (C) medical venture fund. Agricultural and pastoral areas account for medical 2% of the total Fund, used to cover catastrophic Fund due to abnormal increase in the number who, resulting in non-normal cost overruns of the emergency funds. Risk of funds not used for five years in a row, starting from the sixth year will not continue extraction, the proportion of funds into catastrophic Fund in full. Medical risk fund is administered by the County (city, district) established.

    Use of the risk fund, the County (city, district) hospital will submit a written application, (City) approved by the agricultural and pastoral areas of medical management and coordination leading group.

    (City) catastrophic Fund family and clinic accounts of the specific percentage of the Fund from (City) within the range specified in the autonomous region, determined in accordance with local, State administrative departments of public health. 17th medical fund agricultural and pastoral areas and counties (cities, districts) of unified management, Fund for serious illness, outpatient family account funds and risk funds by County (city, district) Management Agency for healthcare administration.

    Implementation of County (city, district) and township (town) of common management, catastrophic funds and risk funds from the County (city, district) medical management, agency management, outpatient family account Fund is administered by the County (city, district) medical management agencies to allocate to the township (town) Management Agency for healthcare administration. 18th pastoral area medical funds adhere to the "storage accounts, earmarks work, separation of revenue and expenditure, separate" management principles.

    No unit or individual shall not borrow, interception, misappropriation and embezzlement in agricultural and pastoral area medical funds. 19th levels in agricultural and pastoral area medical funds should be included in the financial arrangements financial budget and final account.

    The County (city, district) and township (town) medical management agency according to the accounting and financial systems, financial accounting of income and expenses of the Fund, establish and perfect the financial accounting archives and various rules and regulations, standardize financial and accounting management.

    The fourth chapter Medical Fund 20th medical funds should follow so as to achieve, the principle of balance of payments, slightly, open, fair, equitable, timely, convenient and immediate settlement.

    Health savings funds, carried forward to the next year.

    21st the County (city, district) and township (town) medical management agency analysis of fund operation and risk early-warning system should be established, in accordance with the Fund use, improving efficiency.

    22nd farmers following medical treatment:

    (A) the State and autonomous region free medical treatment and new rural cooperative medical assistance;

    (B) access to basic health-care services;

    (C) receive compensation for medical expenses.

    23rd of farmers and herdsmen in outpatient costs incurred by the designated medical institution at all levels, by the accounts of family medicine in their family account cancellation or reimbursement. Article 24th of farmers and herdsmen in the designated medical institutions for treatment in hospital costs incurred at all levels, by the accounts of family medicine and medical cost effective Bill, according to the following proportions in its verification or catastrophic Fund reimbursement.

    In practice (City) and autonomous region levels before the ordination, counties (cities and districts) catastrophic shortage of funds, reported to (City) approval by the Administrative Department of health, can be lowered within 10%.

    (A) the township (town) hospital costs incurred by the designated medical institution, free 90% for individual financing; failing to pay personal finance from 70%.

    (B) in the County (city, district) hospital costs incurred by the designated medical institution, waived or reimbursed for individual financing 85%; 65% failing to pay individual premium waiver or reimbursement.

    (C) in (City) and over hospital costs incurred by the designated medical institution, financing of individual claims in the catastrophic Fund 70%; failing to pay individual premium reimbursement 50%.

    25th Medical Fund claims payment ceiling for the compensation from State health, the competent financial administrative departments and reported to the Government for approval to implement.

    26th patients in the integrated region of farmers and herdsmen in the designated medical institutions in the hospital, discharge patients only pay part of peasants and herdsmen, advance the reimbursement paid by the hospital, domicile of funds paid by patients of medical management agencies in accordance with the regulations and designated medical institutions for immediate settlement or settlement on a regular basis. The 27th of the following circumstances occurs, inpatient medical advances made from the farmers and herdsmen. Discharged with a valid ticket, documents and materials related to a medical certificate to domicile medical management of agencies handling claims of compensation.

    Medical management of agencies handling claims compensation of time shall not exceed 3 months.

    (A) farmers and herdsmen in the integrated work outside the area, visiting relatives, tourism, disease, told in the 5th after admission and manpower areas in agricultural and pastoral area in which medical management agencies; (b) illness treatment needed to co-ordinate areas other than designated medical institutions for treatment. 28th health administrative departments at all levels should carry out farmors major diseases and special diseases medical insurance level pilot project. Included in the reimbursement of compensation of special diseases outpatient medical expenses and reimbursement in the catastrophic Fund 70%. Special diseases outpatient medical costs combined with the inpatient medical costs in the annual maximum reimbursement of compensation limits.

    Major diseases and list of special diseases by autonomous region formulated and published by the Administrative Department of health.

    Kashin-Beck disease treatment costs, Health Fund claims the scope of compensation.

    With the aim of therapeutic rehabilitation medical rehabilitation programs into basic medical coverage, according to local claims compensation standards.

    29th maternal designated medical institutions at all levels of farmers and herdsmen hospital birth and neonatal treatment of medical expenses by the family medical account, County (city, district) referral referral certificate and medical expenses in medical institutions effective instruments, full reimbursement in the catastrophic Fund.

    Sterilization and delivery of maternal families of farmers and herdsmen, waiving their medical costs incurred, by the designated medical institutions free of charge medical cost effective Bill, proof of birth register and signed by the parties, and County (city, district) medical administrative agencies regularly settled in the catastrophic Fund.

    30th State to implement maternal hospital childbirth incentives of farmers and herdsmen, awards funded by the County (city, district) medical management agencies in the catastrophic Fund expenditures. 31st in middle school and primary school children of farmers and herdsmen from its family account fund per person per year in 50%, managed by medical agencies to allocate to the school management, outpatient medical costs paid by the school from the management of funds, balances may be carried forward to the next year. Hospital costs by school prove, family health and medical expenses of the account of the effective instruments at its domicile County (municipal and district) Medical Management Agency reimbursed according to stipulations.

    In high school the children of farmers and herdsmen, domicile claims compensation for medical expenses. Article 32nd outpatient families of farmers and herdsmen account funds in savings in the current year, carried forward to the next year.

    Outpatient families of farmers and herdsmen account funds used, at all levels of medical outpatient costs incurred by the institution, paid by the individual. 

    Article 33rd County (city, district) and township (town) medical administrative agencies shall strictly implement agricultural and pastoral areas medical claims reimbursements, for a variety of documents and vouchers carefully vetted to prevent falsification of related material and other means of obtaining medical fund.

    34th the scope of compensation for medical expenses shall not be reimbursed:

    (A) medical expenses resulting from alcohol, assault, drug abuse;

    (B) commit suicide, self-mutilation (except psychiatric) medical expenses incurred;

    (C) traffic accidents, medical accidents and other medical costs should be borne by a third person;

    (D) the beauty or cosmetic surgery and other non-basic medical needs of the medical costs, Denture costs;

    (E) since the purchase of medicines, nutritional supplements, health care expenditures;

    (Vi) recruitment, recruitment, entrance medical examination, transportation (except for the transport of pregnant and lying-in women in hospital and rescue);

    (G) medical expenses should be paid from the work injury insurance fund;

    (VIII) medical expenses incurred in non-designated medical institutions;

    (I) medical expenses incurred overseas for medical treatment.

    Medical expenses should be borne by a third person according to law, but of a third person cannot be determined, by the agricultural and pastoral areas of medical claims compensation under the Fund.

    Fifth chapter of health services management 35th medical introduction of designated medical institutions for treatment system for agricultural and pastoral areas. Public medical institutions as designated medical institutions at all levels. PLA troops, police medical institutions and non-public medical institutions as designated medical institutions, the local (municipal) health Administrative Department in accordance with the relevant provisions of the State and the autonomous communities for review, evaluation and report upon approval by the Administrative Department of health of the autonomous region, into the designated medical institutions.

    List of designated medical institutions to the public on a regular basis. Medical administrative agencies shall, in accordance with management in agricultural and pastoral areas needed signed a service agreement with designated medical institutions, specify the rights and obligations of both parties. 

    Health administrative departments at all levels should strengthen the supervision of designated medical institutions. Article 36th County (city, district) and township (town) designated medical institutions shall set up a countryside tour to health care systems.

    The County (city, district) medical institutions should be organized periodically by the Administrative Department of health for routine health examination of farmers and herdsmen, and County (city, district) and township (town) hospitals gradually establishing a standardized electronic health records.

    37th designated medical institutions at all levels shall, in accordance with the provisions implementing referral referral system, referral referral shall meet the following conditions:

    (A) the diagnosis is unknown, treatment is not valid, or does not have the diagnosis and treatment of conditions of disease severity, level designated medical institutions on the need to make further checks and treatment;

    (B) the County (city, district) medical management agency approval.

    Condition of farmers and herdsmen in acute and critical, special reasons such as much-needed referral hospitals, counties (cities and districts) and township (town) designated medical institutions should be referred without delay and inform the County (city, district) medical management agency carried out ex-post audits. 

    Article 38th of contracted medical institutions and medical personnel should strictly abide by the code of ethics, due to illness and treatment, strict enforcement of operating standards, procedures and standards in medical technology, medical registration, drug prescriptions, pay as you take notes.

    Ban appointed medical institutions and medical staff without authorization fees, fee increase, beyond the need to check the patient's condition, medication and treatment.

    39th County (city, district) and township (town) medical management agencies and designated medical institutions should be promotional in the obvious location bar and public bar, advocacy and publicity for treatment, reimbursement process and medical reimbursement drug list, clinic directory and in charge of the project, and so on.

    The sixth chapter of medical management and supervision 40th medical, financial, auditing departments should be on the implementation of the measures and their use, supervise and inspect, and report to the people's Governments at the same level.

    Supervision and inspection of the main contents include free medical care implementation of special funds, fund raising, management and expenditure, medical services, drug management, and so on.

    Found problems pastoral area medical supervision process, relevant departments shall promptly correct or processed.

    41st counties (cities, districts), Township (town) medical administrative agencies shall be quarterly or semi-annually to County (municipal and district) and township (town) Council of the medical fund income and expenditure of the HA and usage.

    The 42nd County (municipal and district) medical administrative agencies shall establish a medical fund to reimburse compensation system, specific to the medical fund expenditure, management and benefit farmers and herdsmen be publicized on a regular basis, to ensure participation, knowledge and monitoring of the rights of farmers and herdsmen.

    Farmers have the right to supervise the collection, management and use of the agricultural and pastoral areas of medical fund is entitled to advice and recommendations to the managed care agencies at all levels, and violations of the agricultural and pastoral areas health care system report.

    43rd price administrative departments should strengthen the medical supplies, medical services price management and supervision, control the price level.

    The seventh chapter legal liability

    44th medical management agencies and their staff, one of the following circumstances, the public health Administrative Department shall be ordered to correct serious, head directly by the relevant authorities and persons directly responsible shall be given administrative sanctions; health funds, the losses of farmers and herdsmen, assume liability in accordance with law:

    (A) failing to raise medical funds deposited on account;

    (B) is not in accordance with prescribed standards, requirements and deadlines to pay compensation for agricultural and pastoral areas medical claims;

    (C) other acts in violation of these rules.

    45th medical institutions to provide false evidence, provide conditions for others to defraud health fund claims compensation, the public health administrative departments of medical institutions of 1000 Yuan fine, and holding medical institution directly responsible for managers and other personnel responsibilities.

    46th designated medical institutions to take all means to defraud Fund for agricultural and pastoral areas of medical expenses, by the Administrative Department of public health ordered to return funds fraudulently, fined not more than 5000 Yuan and more than 20000, medical management agencies and the lifting of designated medical services agreement and to hold directly responsible for the charge and the other persons liable.

    47th designated medical institutions not appointed medical institutions of agricultural and pastoral areas in accordance with the service agreement to provide medical services or conduct unreasonable inspections, treatment, medications and pay, by the Administrative Department of public health shall order rectification refuses, medical management agencies and the lifting of designated medical services agreement. 48th agricultural and pastoral areas to embezzle, retain health care funds, agricultural and pastoral areas or compensation other than reimbursement for medical fund medical fund expenditures, by the Administrative Department of public health ordered the recovery; has illegally obtained, confiscation of illegal income directly in charge of personnel and other persons in accordance with the provisions of relevant laws and regulations.

    A suspected crime, transferred to judicial organs for criminal responsibility shall be investigated according to law.

    The eighth chapter supplementary articles

    49th local (municipal) Administrative Office (Government) according to formulate detailed rules for the implementation of the present measures. 50th these measures come into force on January 1, 2013. November 30, 2006, issued by the people's Government of the Tibet Autonomous Region, Tibet Autonomous Region, agricultural and pastoral areas of medical management of the interim measures (the people's Government of Tibet Autonomous Region, 75th) repealed simultaneously.

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