In order to protect the basic medical needs of the insured, standardize and strengthen the supervision and management activities of the basic medical insurance, and maintain the safety of the basic medical insurance fund, these measures are formulated in accordance with the Social Insurance Law of People's Republic of China (PRC) and the actual situation of this Municipality. Article 2 (Scope of Application)

These Measures shall apply to the supervision and management activities of the designated medical institutions for basic medical insurance in this Municipality (hereinafter referred to as designated medical institutions), designated retail pharmacies for basic medical insurance (hereinafter referred to as designated retail pharmacies) and individuals to abide by the provisions of this Municipality on basic medical insurance.

The basic medical insurance mentioned in these Measures includes basic medical insurance for employees and basic medical insurance for urban and rural residents.

The activities of supervision and management of the maternity insurance system and long-term care insurance system with the basic medical insurance fund as the financing channel in this Municipality shall be implemented in accordance with the relevant provisions of these Measures. Article 3 (Supervision and Administration Department of Medical Insurance)

The Municipal Medical Insurance Bureau is the administrative department in charge of the basic medical insurance in this Municipality, and is responsible for the supervision and management of the basic medical insurance in this Municipality. Medical insurance bureau District is responsible for the supervision and management of basic medical insurance within its jurisdiction.

City medical insurance supervision institutions in the name of medical insurance bureau, the specific implementation of the basic medical insurance administrative law enforcement supervision and inspection work, and according to the needs of supervision and management, enrich and strengthen the supervision and inspection force.

Development and reform, health, market supervision, drug supervision, finance, auditing, public security, civil affairs, human resources and social security departments shall, within the scope of their respective duties, cooperate with the supervision and management of basic medical insurance. Article 4 (Medical Insurance Related Information System)

The Municipal Medical Insurance Bureau shall establish and improve the information system of medical practitioners in designated medical institutions and the basic medical insurance expense settlement system, monitor the basic medical insurance expenses incurred by designated medical institutions and their medical practitioners in the process of providing medical services in real time, standardize the medical service behavior of medical practitioners in designated medical institutions, and implement score management for medical practitioners who find irregularities in supervision and management.

Designated medical institutions and retail pharmacies shall, according to the requirements of the city's basic medical insurance network settlement, be equipped with necessary networking equipment, abide by the basic medical insurance information technology specifications and information security related provisions, and timely and accurately upload the basic medical insurance expense settlement and other related information. Article 5 (Service Agreement)

City medical insurance management center is the basic medical insurance agency in this city. In accordance with the relevant provisions of the state and this Municipality, sign service agreements with designated medical institutions, designated retail pharmacies, designated long-term care insurance evaluation institutions (hereinafter referred to as designated evaluation institutions) and designated long-term care insurance nursing institutions (hereinafter referred to as designated nursing institutions).

Designated medical institutions, designated retail pharmacies, designated evaluation institutions and designated nursing institutions violate the provisions of these measures or the service agreement, and the municipal medical insurance management center may suspend or terminate the service agreement. Article 6 (Internal Management)

Designated medical institutions and retail pharmacies shall abide by the provisions and service agreements of the state and this Municipality on basic medical insurance, and establish and improve the internal management system of basic medical insurance.

Three or two medical institutions in designated medical institutions shall set up a department responsible for the management of basic medical insurance, equipped with necessary management personnel; Other medical institutions should be equipped with full-time (part-time) staff to manage the basic medical insurance.

Designated retail pharmacies should be equipped with full-time (part-time) staff to manage basic medical insurance. Article 7 (Management of Medical Insurance Expenses)

Designated medical institutions shall implement the relevant provisions of the city's basic medical insurance budget management and total prepaid expenses management, protect the basic medical needs of the insured, and standardize the use of basic medical insurance funds. Article 8 (Requirements for Providing Services by Designated Medical Institutions)

Designated medical institutions shall, according to the condition of the insured, reasonably select the diagnosis and treatment items and reasonably determine the medication according to the provisions of the basic medical insurance on diagnosis and treatment items, medical service facilities, prescription management and medication scope.

Designated medical institutions to provide medical services for the insured shall abide by the provisions of the basic medical insurance on diagnosis and treatment items, medical service facilities, medication scope, price management and payment standards, and provide medical expense settlement documents to the insured.

Designated medical institutions shall, in accordance with the relevant provisions of the state and this Municipality, provide direct settlement services for medical expenses incurred by insured persons who are not registered in this Municipality. Article 9 (Service Requirements for Designated Retail Drugstores)

Designated retail pharmacies shall not settle the basic medical insurance expenses for prescriptions that do not meet the requirements of basic medical insurance when providing self-purchased prescription drugs and over-the-counter drugs for the insured; Non-prescription drugs provided to the insured shall not violate the provisions of the basic medical insurance on the scope, variety and quantity of drugs.

Designated retail pharmacies to provide dispensing services for the insured shall abide by the relevant provisions of the price management and payment standards, and provide relevant expense settlement vouchers to the insured. Article 10 (Real-time Monitoring)

The municipal medical insurance supervision institution shall conduct real-time monitoring of the insured person's monthly cumulative number of outpatient and emergency visits in designated medical institutions and the basic medical insurance expenses incurred, as well as the basic medical insurance expenses incurred in cumulative dispensing in designated retail pharmacies every month. According to real-time monitoring, if the insured's medical treatment and dispensing exceed the prescribed scope, the district medical insurance bureau and the municipal medical insurance supervision institution may temporarily change the accounting and settlement method of basic medical insurance expenses for outpatient, emergency or dispensing.

If measures are taken to temporarily change the accounting and settlement methods of basic medical insurance expenses, the district medical insurance bureau and the municipal medical insurance supervision institution shall notify the insured and timely review their medical treatment and adjustment. The insured shall cooperate with the audit, explain the situation and provide relevant materials as required.

Upon examination, no violation of the basic medical insurance provisions by the insured was found. The district medical insurance bureau and the municipal medical insurance supervision institution shall resume the accounting and settlement methods of basic medical insurance expenses on the day after the audit is completed.

Upon examination, it is found that the insured violates the provisions of the basic medical insurance, and shall be handled by the municipal and district medical insurance bureaus in accordance with the provisions of the second paragraph of Article 15 or Article 19 of these Measures.