One is to raise funds for urban medical assistance through multiple channels.
County (city, district) people's governments shall establish urban medical assistance funds in accordance with the principle of multi-party financing. Sources of funds include:
(a) the financial department according to the needs of the local area to carry out urban medical assistance work and the ability to pay, arrange urban medical assistance funds in the annual budget. Specifically, it includes: central financial subsidy funds, funds arranged at the provincial level according to the ratio of central financial subsidy amount 1: 1, and urban medical assistance funds arranged by municipal (prefecture) and county (city, district) finances according to the ratio of not less than provincial subsidy funds 1: 1. The specific proportion between the city (prefecture) and the area under its jurisdiction shall be determined by the city (prefecture) government.
(two) provinces, cities (prefectures) and counties (cities, districts) withdraw urban medical assistance funds according to a certain proportion or a certain amount from the welfare lottery public welfare fund reserved for local use;
(three) donations from all walks of life to urban medical assistance;
(four) the interest income formed by the urban medical assistance fund;
(five) other funds that can be used for urban medical assistance according to regulations.
The allocation scheme of provincial subsidy funds is determined by the Finance Department and the Civil Affairs Department according to the number of medical assistance, financial situation and work effectiveness of each city.
Second, formulate rescue standards scientifically and reasonably.
The civil affairs departments of counties (cities, districts) should carefully analyze and calculate the actual expenditure of medical expenses of local relief objects in the previous year or three years in accordance with the principle of living within our capabilities, living within our means, and timely adjust the relief standards according to the actual income and expenditure of urban medical assistance funds.
After deducting the payable part of various medical insurance, the reimbursement part of the unit and social assistance, the personal burden exceeds a certain amount of medical expenses or medical expenses for special diseases to give a certain proportion or a certain amount of subsidies. The specific subsidy standards shall be formulated by the civil affairs departments at the county (city, district) level in conjunction with the health, labor security, finance and other departments at the same level. In principle, the subsidy standards of the same municipal district and the same administrative region should be relatively consistent, and the subsidy standards can be appropriately raised for people with special difficulties.
The civil affairs departments and health departments of local governments at or above the county level shall, through consultation, determine the medical and health institutions that provide medical assistance services for local relief objects, and in principle, formulate the service standards for medical assistance objects with reference to the catalogue of Class A drugs of basic medical insurance for urban workers, the catalogue of diagnosis and treatment projects and the catalogue of medical service facilities.
In principle, the total amount of medical assistance subsidies enjoyed by individuals throughout the year does not exceed the local medical assistance standards, and generally does not exceed 4000 yuan throughout the year.
Third, standardize the definition of the object of assistance
Scope of assistance:
The object of urban medical assistance is the minimum living guarantee for urban residents. The specific conditions shall be formulated by the civil affairs department of the county (city, district) jointly with the departments of health, labor security and finance, and submitted to the people's government at the same level for approval. Persons with special difficulties suffering from special infectious diseases prescribed by the state shall be rescued in accordance with relevant state regulations.
1. Serious illness relief. If the medical expenses for serious illness are unbearable and affect the basic life of the family, assistance shall be given within the prescribed amount of assistance. According to the local actual situation, all localities determine the standards for serious diseases and assistance, and determine the deductible line, capping line and payment ratio of assistance funds. The number of serious diseases recognized in various places should generally be no less than 5.
2. Basic medical assistance. For diseases or common diseases other than serious diseases, medical expenses are relatively high, which affects the basic life of families. During the illness, the patients themselves will be given classified fixed subsidies or guarantee funds to take care of them, and the amount of assistance will generally not exceed 10% of the local annual urban minimum living standard.
3 where conditions permit, we can explore ways to solve medical difficulties by subsidizing the recipients to participate in basic medical insurance and commercial insurance for urban workers.
4. Treatment of special infectious diseases. Appropriate subsidies shall be given to the expenses for the treatment of special infectious diseases stipulated by the state in accordance with relevant regulations.
(two) do not enjoy medical assistance in the following circumstances:
1. Fighting, traffic accidents, alcoholism, drug abuse, suicide, self-mutilation, etc. ;
2. Organ transplantation, tooth implantation, cosmetic surgery, orthopedics, glasses, etc. ;
3. Premarital check-up, health care and rehabilitation. ;
4. Without permission, seek medical treatment or purchase medicines in non-designated medical and health institutions or purchase medicines in non-designated retail pharmacies. ;
5. Other circumstances in which people's governments at or above the county (city, district) level are not allowed to enjoy medical assistance.
Four, strict application, approval and payment procedures for urban medical assistance funds.
City medical assistance funds should be strictly in accordance with the following procedures, the implementation of standardized declaration, approval and payment:
(a) I or the household presided over the receipt of the minimum living guarantee for urban residents and the household registration certificate to submit a written application to the community neighborhood committee, fill in the application form for urban medical assistance, and truthfully provide the medical diagnosis certificate, the receipt of medical expenses, the necessary medical history materials, the subsidy certificate for participating in the basic medical insurance for urban workers or various commercial insurances, and the social mutual aid poverty alleviation certificate. After being audited by the community neighborhood Committee, it will be publicized for 7 days. Without objection, reported by the community neighborhood committee.
(2) Sub-district offices (township people's governments) shall investigate and verify the applicant's medical expenses and family economic status by means of household surveys, neighborhood visits and letters, and report to the civil affairs department of the county (city, district) for approval within 15 days.
(three) the county (city, district) civil affairs department to review the relevant materials submitted by the street office (Township People's Government), and sign the examination and approval opinions within 10 days. Audited in line with the conditions of medical assistance, approved to enjoy the amount of medical assistance, and commissioned by the street offices (Township People's government) and community neighborhood committees to publicize the amount of assistance, publicity for a period of 7 days. Publicity without objection, approved to enjoy medical assistance, and issue relevant documents; If it does not meet the requirements, it shall notify the applicant in writing and explain the reasons.
(four) the civil affairs department of the county (city, district) shall record the accounts of the approved medical aid personnel and report them to the finance department at the same level for examination. After the county (city, district) civil affairs, financial departments to determine the audit, urban medical assistance funds by the county (city, district) financial department from the urban medical assistance financial accounts included in the designated bank directly paid to the relief object. Medical institutions can directly reduce the medical expenses of the relief objects to medical and health institutions through the financial department or the civil affairs department. When examining the amount of medical assistance, the following expenses shall be deducted: the expenses reduced or exempted by medical units according to regulations; Suffering from a serious illness, the expenses subsidized by the target unit or relevant departments, the medical expenses reimbursed by the unit where the family members are located, and the mutual aid funds from all walks of life; Participate in medical insurance benefits paid by basic medical insurance, serious illness medical insurance, supplementary medical insurance, commercial insurance and other medical insurance; Other expenses that should be deducted according to regulations.
Five, strengthen the management of urban medical assistance fund.
The urban medical assistance fund shall be fully used to subsidize eligible medical expenses of the relief object, and no management fee or any other fee shall be drawn from the fund.
Urban medical assistance funds should be included in the financial accounts of social security funds, and special account accounting, special management and earmarking should be implemented. The financial department of the county (city, district) set up a "special account for urban medical assistance funds" in the financial account of social security funds for the collection, disbursement and payment of funds. County (city, district) budget funds allocated quarterly or monthly to the finance department at the same level "urban medical assistance fund accounts"; The lottery public welfare fund approved for urban medical assistance should be transferred from the financial special account to the special account of urban medical assistance fund in time; County (city, district) financial department after receiving the superior subsidy funds, should be timely and fully allocated to the city medical assistance fund special account; Donations from all walks of life and other funds should be promptly deposited in the special account of urban medical assistance fund of the county (city, district) financial department according to the principle of territorial management.
The annual revenue and expenditure plan of the urban medical assistance fund shall be drawn up by the local civil affairs department, audited by the financial department at the same level, and implemented after being approved by the people's government at the same level. The civil affairs department regularly submits the implementation of the revenue and expenditure plan to the finance department at the same level and the civil affairs department at a higher level.
Six, strengthen supervision to ensure the safety of the fund.
The urban medical assistance fund must be fully used for medical expenses subsidies for urban medical assistance recipients, and no unit or individual may intercept, misuse or misappropriate it. Found false impersonator, misappropriation, corruption and waste and other violations of law, in accordance with relevant laws and regulations. To falsely claim the superior subsidy funds, the superior financial and civil affairs departments should reduce or stop allocating subsidy funds according to the situation.
The collection, management and use of urban medical assistance funds, as well as the objects and amount of assistance, shall be regularly announced to the public through posting and other means, and accept the supervision of social cooperation. County (city, district) civil affairs, finance, auditing and other departments should supervise and inspect the use of urban medical assistance funds, find problems should be corrected in time, and report to the local people's government in time. The Provincial Department of Civil Affairs and the Provincial Department of Finance will regularly or irregularly conduct spot checks on the development of medical assistance work and the management and use of funds in various cities.
Municipalities (prefectures) financial and civil affairs departments should proceed from local conditions, strengthen the guidance on the financial management of urban medical assistance funds in pilot areas, arrange subsidy funds in time, sum up and popularize the pilot experience, and ensure the smooth development of the pilot work.