Measures for the Administration of Through Train Reimbursement of Municipal Designated Medical Institutions in Xianyang New Rural Cooperative Medical System (Trial) Chapter I General Provisions Article 1: In order to do a good job in the management of through train reimbursement of municipal designated medical institutions in the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system), simplify reimbursement procedures, facilitate the participation of farmers, and guide the participating farmers to seek medical treatment reasonably, According to the "opinions on further strengthening the construction of the new rural cooperative medical system in our city" (Xian Zhengban made [2008] No.64) and "Notice on issues related to adjusting the operation scheme of the new rural cooperative medical system in our city" (Xian Hehe made [2008] No.5) and the provincial and municipal documents related to the new rural cooperative medical system, these measures are formulated. Second, establish the management system and operation mechanism of reimbursement through train in the designated medical institutions of the new rural cooperative medical system. The reimbursement through train system of the municipal designated medical institutions of the new rural cooperative medical system is organized and implemented by the municipal designated medical institutions and the county (city, district) joint treatment management institutions under the leadership of the municipal joint treatment office. Article 3: The municipal designated medical institutions of the new rural cooperative medical system shall be managed according to the classification of tertiary medical institutions and secondary medical institutions. Chapter II Methods and Standards of Reimbursement Article 4: Reimbursement for hospitalization in municipal designated medical institutions can be divided into fixed subsidies for single diseases and proportional subsidies for non-single diseases. Article 5: The fixed subsidy for single disease shall be implemented. Implementation of the "Xianyang new rural cooperative medical system in hospital single disease quota payment management standards" (2008 edition) (issued separately). The following provisions shall be implemented at the same time: 1. All inpatients diagnosed as single disease only need to pay the out-of-pocket expenses in full when they are admitted to hospital, and the rest will be paid temporarily by designated medical institutions. 2, in line with the "Xianyang new rural cooperative medical system inpatient single disease quota payment management service outline" (issued separately). 3, the patient was diagnosed as a single disease but accompanied by other serious diseases, according to the non single disease subsidy standards. 4, is a single disease disease, before admission in the same designated hospital for continuous outpatient examination fees according to the total bill 35% subsidies. Article 6: Non-single diseases shall be subsidized in proportion. 1, set the starting point of subsidy. The starting point of subsidy for tertiary medical institutions (including secondary hospitals approved by provincial health and price administrative departments to implement tertiary charging standards) and secondary medical institutions is 3,500 yuan (65,438+2100 yuan for children and patients under 04) and 2,500 yuan (65,438+1500 yuan for children and patients under 04) respectively. 2. The hospitalization compliance expenses of patients with non-single diseases shall be reimbursed by 50% (Xingping and Wugong shall be reimbursed by 45%; Qin Dou, acropolis tertiary hospital deductible 800 yuan, deductible expenses above 45% reimbursement, secondary hospital deductible 400 yuan, deductible expenses above 50% reimbursement). 3. The expenses for continuous outpatient examination of participating farmers before hospitalization are included in the scope of hospitalization reimbursement. 4. During hospitalization, due to the lack of conditions in our hospital, the inspection expenses of large-scale instruments and equipment produced by other hospitals were included in the reimbursement scope of our hospital after being approved by the business director of our comprehensive treatment department. 5. For the inspection expenses of large-scale medical instruments and equipment (the inspection expenses of large-scale medical instruments and equipment refer to the single inspection expenses of tertiary hospitals exceeding 150 yuan, and the single inspection expenses of secondary hospitals exceeding 100 yuan) and the disposable medical materials (referring to the 26 domestic popular disposable medical materials clearly stipulated in the Administrative Measures for the Use of Disposable Medical Materials in Provincial Medical Institutions of New Rural Cooperative Medical System in Shaanxi Province (Trial)), firstly, 6, for trauma, respectively, according to two different situations, one is for trauma patients with no clear third responsibility (or trauma with unknown reasons), after excluding other expenses that will not be reimbursed, 30% of the expenses will be paid by the patients themselves, and the balance will be included in the reimbursement scope of combined treatment; Second, the trauma of the third responsible party shall not be compensated in accordance with the relevant provisions of Article 10 of these Measures. Article 7: Set the subsidy ceiling line. Our city has determined that the annual subsidy for each household in the new rural cooperative medical system should not exceed 1.5 million yuan. Municipal designated medical institutions must carefully check the reimbursement records on the certificate of joint treatment when reimbursing the hospitalization expenses of participating farmers. For those who have obtained the highest reimbursement limit 15000 yuan/household/year, the cooperative medical system will not be reimbursed.