For reference only, I hope to consult the relevant departments as soon as I get home. Keep relevant original documents.
I wish you an early return home.
Kenfazheng [2004] No.39
Kenli County People's Government
Thoughts on printing and distributing the management measures of new rural cooperative medical care in Kenli County
Notice of interim measures
Township people's governments, county government departments and units:
The Interim Measures for the Management of New Rural Cooperative Medical System in Kenli County has been studied and passed at the executive meeting of the county government1-12, and are hereby printed and distributed to you, please implement it carefully.
August 2004 13
Interim Measures for the Administration of New Rural Cooperative Medical System in Kenli County
Chapter I General Provisions
Article 1 In order to improve the health security level of rural people, reduce the medical burden of farmers, prevent farmers from becoming poor or returning to poverty due to illness, promote rural economic development and social stability, and accelerate the process of building a well-off society in an all-round way, these measures are formulated in accordance with the relevant provisions of the state, provinces and municipalities and combined with the actual situation of our county.
Article 2 The term "new rural cooperative medical care" as mentioned in these Measures refers to a rural medical security system organized, guided and supported by the government, in which farmers voluntarily participate, and individuals, collectives and other parties raise funds and help each other, which is compatible with the level of economic and social development, farmers' affordability and medical expenses.
Article 3 The new rural cooperative medical system follows the principles of voluntary participation, multi-party financing, fixed expenditure based on income, and appropriate guarantee.
Fourth counties, towns and villages to set up the new rural cooperative medical management committee, under the office, as the agency of the new rural cooperative medical care. The county new rural cooperative medical management office is located in the county health bureau; The management office of the new rural cooperative medical system in villages and towns is located in the township hospitals. The wages and working expenses of the handling personnel are included in the annual budget at the same level.
Health, finance, agriculture, civil affairs, radio and television, auditing, drug supervision, disabled persons' federations and other departments shall, in accordance with the relevant provisions, do a good job in the new rural cooperative medical system in accordance with the responsibilities of the departments.
The main responsibilities of the fifth county new rural cooperative medical management office:
(a) responsible for the organization and coordination of the new rural cooperative medical system in this county;
(two) responsible for the county's new rural cooperative medical fund raising and management;
(3) Formulating relevant supporting management measures;
(four) to provide consulting services for the participants of the new rural cooperative medical system;
(five) according to the arrangement of the county new rural cooperative medical management committee, responsible for the assessment of the county's new rural cooperative medical work, and responsible for the guidance, supervision and inspection of the township cooperative medical office;
(six) to undertake other tasks assigned by the superior.
The main responsibilities of the township new rural cooperative medical management office:
(a) the first instance of hospitalization medical reimbursement credentials, according to the provisions of centralized verification;
(two) responsible for the audit and reimbursement of medical expenses;
(three) to sign a new rural cooperative medical care contract with farmers, provide consulting services and manage health records;
(four) to undertake other tasks assigned by the superior.
Chapter II Fund Raising and Management
Article 6 The new rural cooperative medical system shall implement a financing mechanism combining individual contributions, collective support, government subsidies and social donations, and establish a cooperative medical fund.
Seventh to participate in the new rural cooperative medical system personnel as a unit, the annual payment of individual farmers is not less than 10 yuan, and according to the income level of farmers and the actual needs of the corresponding increase in payment standards.
Rural residents, five objects, disabled soldiers individual pay part, according to the "Interim Measures" management of Dongying farmers' medical insurance. Encourage village collectives and local enterprises to provide financial support for farmers to participate in the new rural cooperative medical system.
Eighth county finance according to the agricultural population per capita 5 yuan standard set up special subsidy funds; Township finance shall be subsidized according to the standard that the per capita agricultural population in the area is not lower than that in 5 yuan. Township finance does not honor subsidies, and county-level special funds will not be compensated. Conditional towns and villages can appropriately raise the subsidy standard. Grant funds must be included in the fiscal budget of the year.
Article 9 Individual contributions of farmers participating in the new rural cooperative medical system shall be collected at one time by the township agricultural tax department on the premise that farmers voluntarily participate in and sign contracts, and shall be handed over to the county new rural cooperative medical system management office before the end of each year 1 1 for use in the next year.
Township financial subsidies should be turned over to the county new rural cooperative medical management office before the end of March of that year.
The county financial subsidy funds were allocated to the county new rural cooperative medical management office before the end of March of that year.
Tenth county new rural cooperative medical management office will deposit cooperative medical funds in state-owned commercial banks, set up special fund accounts, so as to be earmarked.
Eleventh individual farmers to pay the funds, township government subsidies and village collective, enterprise support funds into the management of family account; County-level government subsidies and higher-level government subsidies are included in the management of county-level overall fund accounts.
Twelfth county, township new rural cooperative medical management office, in accordance with the principle of "fixed income, balance of payments", the preparation of the annual budget, submitted to the health administrative department at the same level, the financial department for examination and implementation. Prepare the annual final accounts of the fund at the end of the year, report to the health and finance departments at the same level for review, and accept the supervision and inspection of the finance, auditing and higher health departments.
Thirteenth new rural cooperative medical fund operation cycle should be consistent with the fiscal budget of the year.
Chapter III Utilization of Funds
Fourteenth scope of compensation funds:
(1) Outpatient medical expenses, including medical expenses, operation expenses, routine examination (B-ultrasound, electrocardiogram, radiation), routine examination (routine blood, urine, stool and liver function) and paid service expenses for systematic management of children under 6 years old and pregnant women;
(2) Hospitalization medical expenses, including medical expenses, operation expenses, hospitalization expenses, oxygen delivery expenses, routine examinations (B-ultrasound, electrocardiogram and radiation) and routine tests (blood routine, urine routine, stool routine and liver function).
Fifteenth any of the following circumstances, no compensation:
(a) did not participate in the annual new rural cooperative medical care medical expenses;
(two) the medical expenses incurred by failing to go through the referral procedures as required;
(3) Medical expenses for infectious diseases within the coverage of planned immunization;
(four) the diagnosis of unnecessary and unreasonable inspection fees;
(5) Registration fee, decocting fee, hospitalization food fee, heating fee, house call fee, ambulance fee, special care fee, bed reservation fee, etc. ;
(six) health examination, organ transplantation, blood transfusion, artificial limbs, artificial eyes, dental implants and various beauty, plastic surgery, correction and other expenses;
(seven) medical expenses due to alcoholism, fighting, self-injury, traffic accidents, medical accidents, etc. ;
(eight) the cost of drugs outside the basic drug list of the new rural cooperative medical system;
(nine) medical expenses incurred due to work-related casualties;
(ten) medical expenses caused by natural disasters and other reasons for large-scale emergency, dangerous and serious patients. , solved by governments at all levels;
(eleven) medical expenses incurred in violation of the family planning policy;
(twelve) other new rural cooperative medical care can not be reimbursed for medical expenses.
Sixteenth fund compensation standards:
(a) family account Fund is used to pay compensation for outpatient medical expenses and hospitalization medical expenses below 1000 yuan, and the specific compensation ratio is determined by each township. The rest of the family account Fund shall be carried forward to the next year, but it shall not offset the expenses payable by individuals in the next year.
(two) the county-level overall account fund is responsible for paying the hospitalization expenses 1000 yuan and the compensation of 30 thousand yuan. The compensation amount is calculated by multiplying the hospitalization medical expenses exceeding 1000 yuan by the compensation ratio and the compensation rate of medical institutions. The reimbursement rate from 0 yuan to 6000 yuan is 10065438+20%, and the reimbursement rate from 600 1 yuan to 30000 yuan is 25%; The compensation rate of designated medical institutions below the county level is 100%, that of secondary hospitals at the county level is 90%, that of municipal and secondary public hospitals outside the county level is 80%, and that of public hospitals inside and outside the province is 70%.
In the new rural cooperative medical system for farmers in hospital medical expenses of more than 30 thousand yuan, the county cooperative medical office after the trial report to the city to solve.
(three) in the individual and private medical institutions shall not be reimbursed. Special diseases that really need to be diagnosed and treated by non-designated medical institutions, individuals and private medical institutions shall be strictly controlled by the county rural cooperative medical office.
Seventeenth funds compensation procedures and methods:
(1) Outpatient and hospitalization expenses below 1 000 yuan incurred by farmers in designated medical institutions within their jurisdiction shall be reimbursed by the township new rural cooperative medical management office from family account Fund in proportion.
(II) The hospitalization expenses of 1 000 yuan or more incurred by farmers in designated medical institutions within their jurisdiction shall be reviewed and paid in advance by the township new rural cooperative medical management office, and shall be written off to the county new rural cooperative medical management office every quarter. At the time of reimbursement, if you are hospitalized in a designated medical institution below the county level (excluding the county level), you need to provide hospitalization certificate, medical expenses list, invoice, rural cooperative medical certificate and identity certificate; If you are hospitalized in a designated medical institution at or above the county level (including the county level), you need to provide a referral certificate and a copy of the medical record.
Migrant workers who participate in the new rural cooperative medical system need to submit the diagnosis report of the hospital and the new rural cooperative medical system office in Zaobao County. The compensation for hospitalization medical expenses shall be submitted to the township new rural cooperative medical system office for preliminary examination with my valid certificate, village-level certificate, formal invoice, medical expenses list of non-profit medical institutions in different places and a copy of medical records, and shall be reimbursed according to the prescribed procedures.
(III) County-level serious illness compensation funds shall be allocated once every quarter. According to the hospitalization expenses of patients reported by towns and villages, they shall be allocated to the management office of new cooperative medical care in towns and villages after one-by-one audit, and paid by towns and individuals.
County new rural cooperative medical office in the audit of diagnosis and treatment projects and expense accounts, such as the discovery of the new rural cooperative medical management office in violation of the relevant provisions of the rural cooperative medical system, not to write off, the expenses incurred by the trial unit.
Chapter IV Designated Medical Institutions
Eighteenth new rural cooperative medical system to implement the management of designated medical institutions. The annual inspection system of designated medical institutions shall be formulated and determined by the county new rural cooperative medical office.
Nineteenth designated medical institutions should enhance service functions, improve service quality, meet the needs of the people for disease prevention and treatment, and establish and improve various diagnosis and treatment norms and management systems. The basic drug list, price and basic medical and health service price of the new rural cooperative medical system should be publicized, and the medical service and drug price policy should be strictly implemented.
Twentieth farmers to participate in the new rural cooperative medical system, in principle, the nearest medical treatment. Outpatients and inpatients can see a doctor free of charge in the township where they live. Need to be referred to the county two hospitals or other township hospitals, the township new rural cooperative medical management office is responsible for the referral procedures; Need to be transferred to hospitals outside the county and above the city, by the township new rural cooperative medical management office issued a referral certificate, to the county new rural cooperative medical management office to handle the relevant procedures. In case of emergency (transfer), relevant procedures should be completed within 7 days.
Chapter V Supervision and Responsibility
Twenty-first county and township people's governments shall set up a new rural cooperative medical supervision committee composed of relevant departments and farmers' representatives who participate in the cooperative medical system to supervise the raising, use and management of rural cooperative medical funds.
Twenty-second county and township new rural cooperative medical management office to establish a complaint system. The reported complaints shall be investigated and handled in time, and the complainant shall be informed of the investigation and handling within 15 days.
Twenty-third new rural cooperative medical management office regularly announces the income and expenditure of cooperative medical fund, the payment standard of medical expenses, the object and amount of compensation, and guarantees the participation rights, information rights and supervision rights of participating farmers.
Twenty-fourth the implementation of the new rural cooperative medical fund regular audit system. The audit department should incorporate the income and expenditure and management of the cooperative medical fund into the annual audit plan, conduct regular audits and publish the results.
Chapter VI rewards and punishments
Twenty-fifth county new rural cooperative medical management committee is responsible for organizing the assessment of the county's new rural cooperative medical work. Units and individuals that have made outstanding contributions to the new rural cooperative medical system shall be commended by the county government.
Twenty-sixth new rural cooperative medical management personnel dereliction of duty, abuse of power, corruption, depending on the circumstances given administrative sanctions; If a crime is constituted, criminal responsibility shall be investigated according to law.
Twenty-seventh designated medical institutions of new rural cooperative medical care falsely invoice, issue false certificates, and adjust the compensation items of cooperative medical care in violation of regulations, depending on the seriousness of the case, give informed criticism, make rectification within a time limit, suspend or cancel its designated qualification; If the circumstances are serious, the relevant departments shall investigate their legal responsibilities according to law.
Article 28 Anyone who forges or alters the tickets related to the new rural cooperative medical system, or lends the rural cooperative medical certificate to others to defraud compensation, shall recover the compensation fee according to law, and cancel the household's qualification for compensation in the current year.
Chapter VII Supplementary Provisions
Twenty-ninth approach by the county new rural cooperative medical management office is responsible for the interpretation of.
Thirtieth these Measures shall come into force as of the date of promulgation. The Interim Measures for the Management of Farmers' Cooperative Medical Insurance in Kenli County issued by the county government on May 2, 2003 shall be abolished at the same time.
Keywords: rural cooperative medical care notification measures
Cc: departments of the county party Committee, county discipline inspection commission, county people's congress, county CPPCC, county court,
County Procuratorate and County People's Armed Forces Department.
The office of Kenli County People's Government was issued on August, 2004 13.