I. Main responsibilities of Dongtai Medical Insurance Office
(a) to formulate policies, plans and plans for the city's basic medical insurance, maternity insurance, serious illness insurance, medical assistance, medical prices and other medical security systems, promote the establishment of a long-term care insurance system, establish and improve a multi-level medical security system and organize its implementation. Carry out foreign cooperation and exchanges in the field of medical security.
(two) with the medical insurance fund budget management, organize the formulation and implementation of medical insurance fund supervision and management measures, establish and improve the city's medical insurance fund unified security prevention and control mechanism, organize the action to crack down on fraud to defraud the medical insurance fund. Promote the reform of payment methods of medical security funds.
(3) Organizing the implementation of policies on financing and treatment of medical security, coordinating the financing and treatment standards of urban and rural medical security, improving the dynamic adjustment and regional adjustment and balance mechanism of medical security treatment, and establishing and improving the treatment adjustment mechanism that is suitable for the financing level. Promote the implementation of medical security and precise poverty alleviation.
(four) to implement and organize the implementation of a unified medical insurance catalogue and payment standards for drugs, medical consumables, medical services and medical service facilities, and improve the dynamic adjustment mechanism.
(5) Implement the policies formulated by the higher authorities on the prices of medicines, medical consumables, medical service items and charges for medical service facilities in this Municipality, establish a mechanism for reasonably determining and dynamically adjusting the medical service prices paid by medical insurance, promote the establishment of a market-led social medical service price formation mechanism, and establish a system for price information monitoring, cost investigation and information release.
(six) to implement the bidding policy of drugs and medical consumables formulated by the higher authorities in the city and supervise the implementation, and promote the construction of bidding platform for drugs and medical consumables.
(VII) To formulate the agreement and payment management measures for designated medical institutions in the city and organize their implementation, establish and improve the credit evaluation system and information disclosure system of medical insurance, supervise and manage the medical service behavior and medical expenses incorporated into medical insurance coverage, and investigate and deal with illegal acts in the field of medical insurance according to law.
(eight) responsible for the city's medical security management, public service system construction. Coordinate and promote the informatization, standardization and standardization of medical security in the city. Implement and improve the policy of medical treatment management and expense settlement in different places. Improve the transfer and connection system of medical security relations.
(nine) to complete other tasks assigned by the municipal government.
(10) functional transformation. Improve the unified basic medical insurance system for urban and rural residents, serious illness insurance system and urban and rural medical assistance system, improve the overall level of medical security, establish and improve a multi-level medical security system covering the whole people and urban and rural areas as a whole, continuously improve the level of medical security, ensure the rational use, safety and controllability of medical insurance funds, and promote the reform of "three medical linkages" of medical care, medical insurance and medicine to better protect the medical needs of the people and reduce the burden of medical expenses.
(eleven) the division of responsibilities with the Municipal Health and Wellness Committee. The Municipal Health and Wellness Commission, the Municipal Medical Security Bureau and other departments will strengthen the system and policy convergence in medical care, medical insurance and medicine, establish a communication and consultation mechanism, jointly promote reform, and improve the efficiency of the use of medical resources and the level of medical security.
Second, Dongtai Medical Insurance Office has internal organs.
(1) office.
(2) Treatment Guarantee and Medical Service Management Section.
(3) Drug Price and Bidding Procurement Section.
(4) Fund Supervision Section (Information Management Section).
legal ground
Article 5 The people's governments at or above the county level shall strengthen their leadership over the supervision and management of the use of medical insurance funds, establish and improve the supervision and management mechanism and law enforcement system of the use of medical insurance funds, strengthen the capacity building of the supervision and management of the use of medical insurance funds, and provide guarantee for the supervision and management of the use of medical insurance funds.
"Regulations on the Supervision and Administration of the Use of Medical Insurance Funds" Article 7 The State encourages and supports the news media to carry out public welfare publicity of medical insurance laws, regulations and medical insurance knowledge, and to supervise the use of medical insurance funds by public opinion. Publicity and reports on medical security should be true and fair.
The people's governments at or above the county level and their medical security administrative departments shall solicit opinions in writing, hold symposiums, listen to the opinions of deputies to the National People's Congress, members of the Chinese People's Political Consultative Conference and representatives of insured persons on the use of medical security funds, unblock social supervision channels, and encourage and support all sectors of society to participate in the supervision of the use of medical security funds.
Medical institutions, pharmaceutical business units (hereinafter referred to as pharmaceutical institutions) and other units and medical and health industry associations shall strengthen industry self-discipline, standardize medical service behavior, promote industry norms and self-discipline, and guide the rational use of medical security funds according to law.
"Regulations on the Supervision and Administration of the Use of Medical Security Funds" Article 9 The state establishes and improves a unified national medical security handling management system, provides standardized and standardized medical security handling services, and realizes full coverage of provinces, cities, counties, towns (streets) and villages (communities).