(Civil Affairs Bureau, Finance Bureau, Medical Insurance Central Bureau, Labor Day Security Bureau)
Yang Zhengmin [2009] No. 41 and Yang Caishe [2009] No. 17)
County (city, district) Civil Affairs Bureau, Finance Bureau, Health Bureau, Labor and Social Security Bureau:
In order to conscientiously implement the "Yangzhou City Interim Measures for the Implementation of Social Basic Medical Assistance" (Yangzhou Government Office In the spirit of the "Yangzhou City Emergency Assistance Management Measures for People in Temporary Needs" (Yangfu Banfa [2008] No. 107) and the "Yangzhou City Emergency Assistance Management Measures for People in Temporary Needs" (Yangfu Banfa [2008] No. 107), the "Yangzhou City Implementation Rules for Medical Assistance for Poor People" are hereby issued to you. Please pay attention carefully. Follow it.
February 27, 2009
Yangzhou City’s Implementation Rules for Medical Assistance for Needy People
According to the "Yangzhou City Interim Measures for the Implementation of Social Basic Medical Assistance" (Yangfu Banfa [2004] No. 127) and the municipal government's "Yangzhou City Emergency Assistance Management Measures for People in Temporary Needs" (Yangfu Banfa [2008] No. 107), in order to improve the city's temporary assistance system and increase medical treatment for people in need These detailed rules are formulated based on the rescue efforts and the actual conditions of our city.
1. Medical assistance recipients
Urban residents as mentioned in these Measures refer to urban residents who participate in urban employee and resident medical insurance in the administrative areas of Guangling District, Weiyang District and Development Zone . Specifically include:
1. Urban residents who hold the "Urban Resident Minimum Living Security Certificate" (dibao) issued by the civil affairs department.
2. Urban extremely poor employees holding the "Extremely Impoverished Employee Certificate" issued by the Municipal Federation of Trade Unions.
3. The three-no objects mainly include the three-no objects adopted by the Municipal Social Welfare Center, the three-no objects admitted to Wutaishan Hospital and Huimin Hospital, the homeless and beggars, and the three no-objects scattered in society.
4. Low-income marginalized groups suffering from major diseases such as malignant tumors, leukemia, and uremia (retired employees who received regular and quantitative living subsidies from the civil affairs department in the 1960s, preferential treatment recipients, etc.) and other difficulties resident.
5. Those in need who are impoverished due to illness
6. Other assistance recipients determined by the municipal government.
2. Medical assistance methods and standards
1. Insurance assistance. In addition to those who have participated in urban employee medical insurance, other eligible subjects in low-income groups and extremely poor employees will participate in urban resident medical insurance with full funding. After participating in the insurance, they will enjoy the medical care stipulated in the "Yangzhou City Urban Resident Medical Insurance Interim Measures" Insurance benefits.
2. Pre-medical assistance. For extremely poor employee patients suffering from malignant tumors, leukemia (including bone marrow transplantation), uremia (including kidney transplantation), or in urgent need of assistance, if the down payment of medical expenses exceeds their annual family income, the district civil affairs and finance departments will prepay no more than 2,000 yuan. Pre-hospital medical assistance funds go into the accounts of designated medical institutions.
3. Relief of chronic diseases. It is used for patients with chronic diseases such as hypertension, diabetes, tuberculosis, rheumatoid, mental illness, hepatitis, asthma, lupus erythematosus and other chronic diseases. , the district finance will provide a drug purchase subsidy of 300 yuan per person per year.
4. Immediate assistance. Low-income residents and extremely poor workers who participate in urban residents' medical insurance should seek medical treatment in designated medical assistance hospitals. In addition to normal settlement according to the resident medical insurance policy, designated hospitals should provide the following immediate assistance for medical expenses that are within the scope of the resident medical insurance report:
(1) General outpatient expenses (except for three special diseases), patients For medical expenses that continue to occur after the personal account expenses are used up, if the annual cumulative part is less than 5,000 yuan, 60% of the expenses will be reduced.
(2) For hospitalization expenses (including outpatient expenses for three special diseases), the annual expenses between 1,000 yuan and 70,000 yuan will enjoy a 20% fee reduction.
5. Serious illness assistance. Patients with major diseases (malignant tumors, leukemia, uremia) whose annual cumulative outpatient and inpatient medical expenses exceed 2,000 yuan (within the scope of medical insurance reimbursement) will be provided with temporary assistance, with the maximum annual assistance limit of 30,000 yuan.
(1) Provide 40% assistance to subsistence allowance recipients and poor workers.
(2) Provide 30% assistance to those on the margins of subsistence allowances.
(3) Provide 20% assistance to other people in need (referring to people in need whose annual family income is less than the medical expenses paid by individuals and who have no other funds to pay for medical expenses).
6. Provide rescue according to actual situation. Medical institutions designated by the government should provide targeted assistance to the three no-goes.
3. Medical assistance application approval procedures and fund settlement methods
1. Insurance assistance. Before the end of April every year, the civil affairs department submits the list of aid recipients to the Municipal Social Security Center for verification, and then uniformly applies for urban resident medical insurance for eligible aid recipients. The municipal labor and social security department is responsible for approval and issuance of medical insurance cards.
2. Pre-medical assistance. Applicants should submit a written application to the district civil affairs department where their household registration is located, and attach relevant materials such as household registration book, resident ID card, income certificate, and major disease diagnosis certificate. The district civil affairs department should complete the investigation and verification within 7 working days. If the conditions for pre-hospital medical assistance are met, the district financial department will implement the rescue, and the rescue funds will be credited into the account of the designated medical institution.
3. Relief of chronic diseases. Low-income residents and extremely poor workers suffering from prescribed chronic diseases should submit a written application to the district civil affairs department where their household registration is located, and attach relevant materials such as household registration book, resident ID card, income certificate, and chronic disease diagnosis certificate. After review by the district civil affairs and finance departments, the district finance department shall provide assistance.
4. Immediate assistance. If the minimum subsistence allowance recipients and extremely poor employees seek medical treatment in government-designated medical institutions and meet the provisions of direct assistance funds, the medical institutions will submit relevant materials to the Municipal Medical Insurance Center for review within five working days after the end of each quarter, and the municipal finance department will settle the funds.
5. Serious illness assistance.
(1) For subsistence allowance recipients, extremely poor workers, and low-income marginal recipients, medical institutions designated by the government will provide direct assistance for serious illnesses in accordance with regulations. After medical institutions submit relevant materials to the Civil Affairs Bureau and Medical Insurance Center for review, the municipal finance department will conduct fund settlement.
(2) Other assistance recipients should submit written applications to the district civil affairs department where their household registration is located on a quarterly basis, and attach household registration books, resident ID cards, income certificates, major disease diagnosis certificates, medical insurance reimbursement settlement lists and related vouchers and other related materials. After preliminary review, the district civil affairs department and financial department should publish the "Yangzhou City Temporary Assistance Application Form" and "Yangzhou City Temporary Assistance Summary Form" (in quadruplicate) to the public within 5 working days after the end of each quarter. The municipal government will compile the joint review materials and submit them to the municipal finance department. After being reviewed by the municipal finance, the subsidy funds will be directly allocated to each district and distributed uniformly by the civil affairs department of each district.
6. Provide rescue according to actual situation. For those with "three no's", the civil affairs and financial departments will determine the base and quota every year, and provide assistance according to the actual situation.
(1) For the "three no's" persons adopted by the Municipal Social Welfare Center, the "three no's" mental patients and vagrants and beggars admitted to the city's Wutaishan Hospital and Huimin Hospital, the relevant units must report them before the end of each year. Truthfully submit the list of aid recipients and the list of expenses, and after review by the civil affairs department, report to the municipal finance department.
(2) For the "three no objects" scattered in society, the district civil affairs and financial departments will first provide assistance, and truthfully submit the list of assistance objects and the list of expenses before the end of each year, and submit it to the civil affairs department After review, it will be reported to the municipal finance department.
IV. Designated hospitals and medical treatment
1. Determine Yangzhou Huimin Hospital as the designated hospital for social basic medical assistance, and Yangzhou First People’s Hospital as the technical guidance hospital and first diagnosis hospital As referral hospitals, Yangzhou Wutaishan Hospital is a psychiatric collaborative hospital, and Yangzhou Third People's Hospital is a designated hospital for infectious diseases.
2. In principle, rescue objects should seek medical treatment in designated hospitals. Emergency patients can receive emergency rescue at the nearest medical institution, but their family members should go to the designated hospital within 5 working days with an emergency certificate. The referral registration procedures and medical expenses incurred shall be carried out in accordance with the relevant provisions of these rules.
If a designated hospital really needs to transfer a patient to another hospital for treatment due to limited conditions, the specialist director of the hospital will provide a referral opinion. Only after review by the medical department of the hospital and approval by the medical assistance office of the designated hospital can you go to a hospital in or outside the city determined by basic medical insurance. The medical expenses incurred will be settled in accordance with the relevant provisions of these rules.
5. Division of responsibilities for medical assistance
All relevant departments must conscientiously identify and review temporary assistance recipients, improve the temporary assistance information exchange mechanism, and clarify responsibilities and benefits. resource.
The civil affairs department is responsible for the organization and coordination of temporary rescue work and the review of rescue objects.
The financial department is responsible for the budget arrangement and supervision of the use of disaster relief funds.
The labor and social security department is responsible for the accounting of urban residents’ medical insurance and medical assistance expenses for assistance recipients.
The health department is responsible for providing diagnosis and treatment services to rescue recipients, supervising medical service activities, and supervising designated medical institutions.
6. Raising and managing medical assistance funds
Medical assistance funds are raised through the following methods:
1. The municipal finance allocates special funds in the budget every year;
2. Donations from citizens, legal persons, organizations and other social organizations;
3. The local retained portion of the welfare lottery public welfare fund of the civil affairs department;
4. Society The balance of the basic medical insurance critical illness overall fund (disbursed based on the actual insured amount);
5. Withdraw 8% of the employment security fund for persons with disabilities in accordance with regulations;
6. Medical assistance fund The value-added part;
7. Other legal income.
The basic social medical assistance funds are managed by the municipal finance department, and a special fiscal account for Yangzhou City’s basic social medical assistance funds is established for special use. According to regulations, all medical assistance fund income is turned over to the special financial account.
Seven. Supervision and Punishment
1. The specific implementation of medical assistance should be based on the principles of openness, fairness and impartiality, adhere to the democratic review and publicity system, and be widely subject to social supervision. Review aid recipients, aid fund issuing units and designated hospitals should accept visits and investigations of medical aid work from civil affairs, finance, labor and social security agencies, truthfully report the situation and provide required materials.
2. If medical assistance recipients commit the following acts, they will be disqualified from receiving medical assistance.
(1) Failure to fill in the application form truthfully and commit fraud;
Give the "Minimum Guarantee" and "Specially Hardship Employee Certificate" to others;
(3) ) Failure to pay the fees that should be paid by the individual without justifiable reasons;
(4) Seeking medical assistance by other improper means.
3. If relevant departments and personnel responsible for medical assistance cause losses of medical assistance funds due to negligence or abuse of power, the relevant departments and personnel should be held accountable; if a crime is constituted, criminal responsibility will be pursued in accordance with the law.
8. Each county (city) can refer to the implementation details of local medical assistance measures.
9. These implementation rules shall come into effect from the date of issuance.