Chapter I General Provisions

Article 1 is based on the Decision of the Central Committee of the State Council on Further Strengthening Rural Health Work (Zhong Fa [2002] 13) and the Notice of the General Office of the People's Government of Anhui Province on Forwarding the Opinions of the Provincial Health Department, the Provincial Department of Finance and the Provincial Agricultural Committee on Establishing a New Rural Cooperative Medical System (Anhui Zhengban [2003]3 1 3).

Article 2 The new rural cooperative medical system as mentioned in these Measures is a system of mutual medical assistance and economic assistance for farmers, which is organized, guided and supported by the government, in which farmers voluntarily participate, and individuals, collectives and the government jointly raise funds.

Article 3 The implementation of the new rural cooperative medical system shall follow the following principles:

(a) The principle of family-based voluntary participation and multi-party financing by government organizations and farmers;

(two) the principle of balance of payments, ensuring moderation, slight balance and gradual adjustment;

(three) the principle of taking into account the interests of farmers;

(four) farmers' representatives to participate in management and supervision, and implement the principles of openness, fairness and justice.

Chapter II Scope and Object of Implementation

Article 4 All rural residents in this area can participate in the new rural cooperative medical system.

Chapter III Organizational Structure and Responsibilities

Article 5 The Xuanzhou New Rural Cooperative Medical Management Committee (hereinafter referred to as the District Cooperative Medical Management Committee) shall be established, with the principal responsible comrades of the district government as the director, the responsible persons of the district committees and governments as the deputy directors, and the members composed of responsible comrades of the district government offices, health, finance, civil affairs, agriculture, publicity, personnel, public security, development and reform, auditing and other departments and farmers' representatives. Set up an office (hereinafter referred to as the District Cooperative Medical Management Office), located in the District Health Bureau. The District Cooperative Management Committee is the organization, leadership and coordination management institution for the implementation of the new rural cooperative medical system in the whole region.

The responsibilities of the regional coordination committee are:

(a) responsible for the implementation plan of cooperative medical care;

(two) responsible for the organization and implementation of publicity and programs;

(3) Coordinating relevant government departments to perform their respective duties;

(four) responsible for the implementation of matching funds;

(five) to arrange the collection of cooperative medical fund and examine and approve the annual work plan;

(six) responsible for the establishment of township offices cooperative medical leadership and management institutions, examination and approval of designated medical institutions;

(seven) the organization of experience exchange, work discussion, assessment, rewards and punishments;

(eight) in conjunction with the relevant departments to solve the problems related to the implementation of the new rural cooperative medical system;

(nine) responsible for the supervision of designated medical institutions, investigate and deal with violations of relevant regulations;

(ten) report to the Party committees, people's congresses, governments and cooperative medical supervision committees at the same level.

The responsibilities of the district joint management office are:

(a) responsible for the daily work of the community management committee, formulate the annual work plan;

(two) responsible for regularly reporting the operation of cooperative medical care to the district management committee;

(three) to be responsible for the management of the cooperative medical fund, and to supervise and inspect the joint management institutions of the township offices;

(four) responsible for the publicity of the fund's income and expenditure and use;

(five) responsible for statistics and information management;

(six) to complete other tasks assigned by the District Management Committee.

Article 6 The Xuanzhou District New Rural Cooperative Medical Supervision Committee (hereinafter referred to as the District Cooperative Medical Supervision Committee) shall be established, with the secretary of the District Discipline Inspection Commission as the director, the leaders in charge of the District People's Congress and CPPCC as the deputy directors, and the members shall be composed of the heads of the district supervision, auditing, price control departments and farmers' representatives.

The responsibilities of the District Cooperation Supervision Committee are:

(a) to check the financial situation of the cooperative medical system and supervise the use of the cooperative medical fund;

(two) to investigate and deal with violations of law and discipline in the cooperative medical care work;

(three) other problems found in the daily supervision work, can be suggested to convene a meeting of members of the cooperative medical management committee to solve in time.

The district joint supervision Committee has an office, and the director of the supervision bureau is also the director.

Article 7 The Xuanzhou New Rural Cooperative Medical Management Center (hereinafter referred to as the district joint management center) is established as a full-time deputy-level institution, and the full-time career establishment is approved 1 1. The Director of Health Bureau is concurrently the director and one full-time deputy director.

The responsibilities of the district joint management center are:

(a) to handle the daily affairs of cooperative medical care;

(two) the full implementation of the "implementation plan" and the annual work plan;

(three) to put forward opinions and suggestions on the modification and improvement of the implementation plan;

(4) Formulating and implementing relevant work systems;

(five) responsible for the management and accounting of the special account of the cooperative medical fund, and regularly report the use of the fund to the cooperative medical management committee;

(six) examination and approval of medical referral, medical expenses compensation and settlement procedures;

(seven) examination and approval of medical institutions, the development of designated medical institutions;

(eight) do a good job in the reporting, information management and release of relevant statistical reports.

Eighth township offices set up a new rural cooperative medical care leading group and supervision group. The leading group is composed of the main leaders of the party and government, leaders in charge, representatives of insured farmers and responsible persons of relevant functional units, and is responsible for the organization, publicity, guidance and management of the implementation of the new rural cooperative medical system. The supervision team is led by the full-time chairman or vice-chairman of the National People's Congress and composed of representatives of insured farmers, who are responsible for supervision.

Ninth township offices to set up cooperative medical management station (hereinafter referred to as the joint management station), by the township office in charge of the leadership of the stationmaster, members of the health, finance, agriculture, civil affairs and other units responsible comrades and farmers' representatives.

The joint management station is a new rural cooperative medical management institution within its jurisdiction, and its responsibilities are:

(a), the implementation of new rural cooperative medical policies and regulations, responsible for the collection and payment of insured persons;

(two), to assist the district management center to pay compensation;

(three), responsible for submitting information reports, timely publication of accounts, collecting and feedback farmers' opinions and suggestions on the implementation of the new rural cooperative medical system;

(four) to complete other tasks assigned by the district joint management office and the township office.

Tenth administrative villages set up a new rural cooperative medical care management team, the village director is the coordinator of the new rural cooperative medical care, responsible for promoting and mobilizing farmers to participate in the cooperative medical care, assisting in collecting farmers' participation funds and promoting the collection and use of cooperative medical care funds.

Chapter IV Fund Raising and Management

Article 1 1 individual contributions to the fund. All farmers participating in the new rural cooperative medical system are paid by their families according to the standard of 10 yuan per person per year, and the township government and sub-district offices are responsible for raising funds. The district joint management center signed an insurance agreement with the participating farmers, and issued a special receipt voucher for cooperative medical care supervised by the district joint management Committee to the participating farmers, and issued a medical certificate for the new rural cooperative medical care in Xuanzhou District (hereinafter referred to as the medical certificate). The insurance premium paid by individual farmers belongs to personal consumption expenditure and should not be regarded as increasing the burden on farmers.

Article 12 The government subsidizes funds. According to the actual number of insured persons, in 2007, the central government subsidized 20 yuan per person, and the provincial, municipal and district governments allocated 20 yuan per person according to 9, 4 and 7.

Article 13 Support the Endowment Fund. Encourage township offices, village collectives and relevant economic organizations and individuals to support and donate to the cooperative medical system, and the funds for their support and donation shall be collected by the special receipt issued by the district joint management center and incorporated into the unified management of the cooperative medical system fund.

Fourteenth rural five-guarantee households and poor households to participate in the individual payment by the civil affairs department unified arrangements to pay.

Fifteenth district management center to set up a special account for cooperative medical fund in the designated bank. The individual contributions of the insured, financial subsidies at all levels and donations supported by relevant economic organizations are all deposited in special fund accounts, and expenditure accounts are opened, and the management of two lines of revenue and expenditure is strictly implemented, and the funds are earmarked for special purposes. No unit or individual may occupy or misappropriate special funds for cooperative medical care. The personnel and working funds of the cooperative medical service agency shall be included in the financial budget at the same level, and shall not occupy the cooperative medical service fund.

Article 16 The collection agency of the new rural cooperative medical fund in the township office may set up short-term income transition households to temporarily record the income, interest income and other income of the rural cooperative medical fund collected by the collection agency of the township. The agency shall pay the collected cooperative medical fund into the special account of the district cooperative medical fund within the specified time, so that there is no balance at the end of the month.

Seventeenth the establishment of cooperative medical fund financial management system, accounting system and internal audit system.

Chapter V Measures for Compensation of Medical Expenses

Eighteenth in order to improve the ability to resist the risk of disease, taking into account the interests of farmers, the new rural cooperative medical fund in our region is divided into overall account and family account. The compensation scope of the overall fund includes hospitalization expenses compensation, chronic disease outpatient expenses compensation, and hospitalization delivery quota compensation.

Nineteenth family account Fund for outpatient expenses compensation. All insured persons extract 5 yuan from the cooperative medical fund every year and bring it to family account. Family account can accumulate and inherit it every year, but cash cannot be withdrawn or used for other purposes. The overall fund and family account Fund are accounted for separately, managed separately, and do not occupy each other.

Twentieth hospitalization expenses compensation:

1, hospitalization expenses are compensated by stages. Qifubiaozhun: 200 yuan, a township-level medical institution, 300 yuan, a district-level medical institution, and 500 yuan, a medical institution inside and outside the district (including private medical institutions). The items below Qifubiaozhun are paid by individuals, and the reimbursement ratio of items above Qifubiaozhun is shown in the following table:

Proportion table of hospitalization medical expenses compensation:

Hospitalization expenses (yuan) medical institutions, township hospitals, district hospitals, hospitals above the district level and hospitals outside the district (including private hospitals)

Qifubiaozhun -200040%30%20%

200 1-500050%40%30%

500 1- 1000060%50%40%

/kloc-above 0/0000 70%70%60%

2, five guarantees and poor households hospitalization expenses reimbursement Qifubiaozhun.

3. The time interval between two hospitalizations due to the same disease should be calculated within 15 days.

4. The maximum compensation for the accumulated hospitalization medical expenses of the insured for the whole year is 20,000 yuan.

5. The hospitalization expenses shall be paid by the individual first, and then the compensation formalities shall be handled after the treatment.

6, to participate in the new rural cooperative medical care farmers, did not use the cooperative medical fund, their family members to determine one person to enjoy a routine physical examination.

Twenty-first chronic disease outpatient fee compensation:

Some patients with chronic diseases identified by medical experts organized by the district joint management center can enjoy reimbursement for medical expenses incurred in outpatient treatment of designated medical institutions with the "Xuanzhou New Rural Cooperative Medical System for Chronic Diseases". The reimbursement ratio is: 25% for township-level medical institutions, 20% for district-level medical institutions, and 15% for medical institutions inside and outside the district, with a cumulative maximum compensation of 2,000 yuan per person per year.

The chronic diseases mentioned in this plan refer to: ① hypertension above grade 2 (including grade 2); ② Heart disease complicated with cardiac insufficiency; ③ Diabetes with ineffective diet control; ④ decompensated cirrhosis; ⑤ Recovery period of cerebral hemorrhage and cerebral infarction; ⑥ Radiotherapy and chemotherapy for malignant tumor; ⑦ Dialysis treatment of chronic renal insufficiency; ⑧ Mental maintenance therapy; Pet-name ruby advanced schistosomiasis with liver function damage; Attending tuberculosis.

Twenty-second patients with chronic diseases hospitalization expenses compensation ratio with reference to twentieth.

Twenty-third hospital delivery quota compensation:

Women who participate in cooperative medical care can enjoy fixed compensation for medical expenses incurred in hospital delivery in designated medical institutions, and the compensation standard is 200 yuan per person. Family childbirth and childbirth in violation of the family planning policy are not covered by compensation. Obstetric complications and complications are compensated according to hospitalization.

Twenty-fourth district new rural cooperative medical system hospitalization compensation scope:

Medical expenses, operation expenses, materials expenses, hospitalization expenses, treatment expenses, laboratory expenses, inspection expenses, blood transfusion expenses during operation or with clear indications for blood transfusion, etc. The drugs used in the new rural cooperative medical system shall be implemented in accordance with the Catalogue of Essential Drugs for the New Rural Cooperative Medical System in Anhui Province.

Twenty-fifth the following circumstances do not belong to the scope of compensation:

(1) all medical expenses except the List of Essential Drugs of New Rural Cooperative Medical System in Anhui Province (Trial) (No.Wan Nong [2005] 17).

(2) Medical expenses incurred by the insured due to illegal crimes, fights, alcoholism, suicide, traffic accidents, medical accidents, sexually transmitted diseases and human factors.

(3) Services: registration fee, medical record fee, visiting fee, expedited fee for examination and treatment, surcharge for roll call operation, etc. Various beauty, bodybuilding projects and non-functional cosmetic surgery, orthopedic surgery, weight loss, weight gain and height increase projects.

(4) Equipment and medical materials: glasses, dentures, artificial eyes, artificial limbs, hearing AIDS and other rehabilitation devices. All kinds of self-use health care, massage, examination and treatment equipment, etc.

(5) Service facilities: transportation fee for medical treatment (referral), first aid fee, air conditioning fee, baby incubator fee, refrigerator fee, escort fee, nursing fee, washing fee, outpatient decoction fee, meal fee, etc.

(6) Special examination and treatment fees: γ knife, X knife, cardiovascular radiography X-ray machine, magnetic vibration, scanning CT, color Doppler, linear accelerator, extracorporeal shock wave lithotripsy, hyperbaric oxygen therapy, pacemaker, artificial joint, intraocular lens, vascular stent and other artificial organs replaced in vivo and implanted materials in vivo.

Twenty-sixth annual final accounts of the fund balance is too large, the annual cumulative outpatient expenses of patients with non-chronic diseases exceed 500 yuan, and the participating farmers who have received compensation of 20,000 yuan, if there are still large medical expenses, can make a second compensation. The specific compensation scheme will be studied by the district coordination meeting.

Chapter VI Procedures for Compensation of Medical Expenses

Article 27 The outpatient medical expenses paid by the participating farmers in family account shall be written off by the designated medical institutions on the family account card, and the designated medical institutions shall be responsible for filling out the settlement form of outpatient medical expenses, with prescriptions and official invoices attached, and shall make monthly settlement at the district joint management center.

Twenty-eighth participating farmers in the designated medical institutions in the area of hospitalization expenses and hospital delivery expenses, and the designated medical institutions direct settlement compensation. After the participating farmers go through the discharge procedures, they will go through the compensation procedures at the settlement window of cooperative medical expenses of medical institutions with the diagnosis certificate, ID card, discharge summary, special prescription and expense invoice, and the designated medical institutions will review and cash the compensation.

Article 29 The designated medical institutions shall submit the reimbursement materials of the participants discharged from the hospital last month to the district joint management center before 15 every month, and the district joint management center will report the audit results to the designated medical institutions, and pay compensation in the next month after the audit is correct.

Thirtieth by the district management center audit, does not meet the requirements of the new rural cooperative medical policy compensation fees, district management center will not pay, the cost borne by the designated medical institutions; The cost of insufficient compensation, the difference is directly allocated to the township office joint management station by the district joint management center, and the joint management station is responsible for cashing the participating objects.

Article 31 When allocating compensation to medical institutions, the district joint management center shall first allocate 90% of the payable amount, and reserve 10% as the management deposit, which shall be allocated according to the assessment at the end of the year.

Article 32 Participants who go out (outside the district) for emergency hospitalization shall be treated in medical institutions organized by governments at or above the township level, and apply to the district joint management center for filing within 3 working days. The expenses are paid by the individual first. At the end of the treatment, relevant hospitalization materials, such as identity certificate, discharge summary, medical expense invoice, etc., shall be issued, and compensation procedures shall be handled at the district joint management center.

Thirty-third migrant workers (residents) who are hospitalized in medical institutions organized by local governments at or above the township level shall apply to the district joint management center for filing within 7 working days, and the expenses shall be paid by individuals first. After the treatment, relevant hospitalization materials such as identity certificate, discharge summary and medical expense invoice should be issued, and compensation procedures should be handled at the district joint management center.

Thirty-fourth outpatient expenses for chronic diseases shall be paid by individuals first. After the expenses occur, they shall go through the compensation procedures at the district joint management center with ID card, chronic disease treatment certificate, treatment certificate, prescription, medical expense invoice and other materials.

Thirty-fifth compensation object must hold my identity card and "diagnosis" to receive compensation. Special circumstances can not be handled in person, can only be handled by their immediate family members or entrusted by the village coordinator, the agent needs to provide two ID cards, household registration books and "medical certificate".

Chapter VII Medical Services and Medical Management

Article 36 The system of designated medical institutions shall be implemented. Designated medical institutions shall be determined by the District Management Committee, and dynamic management shall be implemented. The district joint management center signed a medical service agreement with designated medical institutions and used special prescriptions for cooperative medical care.

Article 37 The insured shall abide by the rules and regulations of the new rural cooperative medical system, seek medical treatment in the designated medical institutions in the region, and shall not lend my Medical Certificate to others for medical treatment, or instruct medical personnel to cheat, or alter medical invoices, medical records and prescriptions.

Article 38 If a patient hospitalized in a designated medical institution needs to be transferred to a hospital at or above the district level or outside the district, he/she shall obtain a transfer certificate from the district-level medical institution, which shall be signed by the competent dean and approved by the district joint management center. After leaving the hospital, he will go to the district joint management center for cost compensation with the transfer certificate, medical invoice, diagnosis certificate and medical records.

Thirty-ninth designated medical institutions should strengthen the publicity of medical personnel on the relevant policies and regulations of the new rural cooperative medical system, strictly abide by the relevant rules and regulations, change the concept of medical service, and enhance the awareness of cost control. It is necessary to adhere to the treatment due to illness, reasonable examination, rational drug use, rational treatment and standardized charges, and control the outpatient dosage (within 2 weeks of chronic diseases) within 3 days, and control the discharge dosage within 7 days, so as to effectively provide high-quality, efficient, low-consumption and convenient medical services for the insured.

Fortieth district joint management center announced the list of designated medical institutions at the beginning of each year, and issued signs of designated medical institutions. All designated medical institutions should hang signs in a conspicuous position to facilitate the insured farmers to seek medical treatment.

Forty-first insured in the next year did not continue to participate in the insurance, family account surplus funds automatically transferred to the overall account.

Chapter VIII Reward and Punishment

Forty-second units and individuals that have made remarkable achievements in the implementation of the new cooperative medical system shall be commended and rewarded by the district government.

Forty-third in violation of this plan and related supporting regulations, the administrative department of health in conjunction with relevant departments shall be investigated and dealt with according to law. For abuse of power, corruption, dereliction of duty, resulting in significant impact and serious consequences, the person directly responsible shall be given disciplinary sanctions, administrative sanctions or dismissal until the leadership responsibility of the unit is investigated. Those who violate the criminal law shall be transferred to the judicial department for criminal responsibility according to law.

Forty-fourth designated medical institutions do not comply with the management regulations, resulting in confusion in management and low quality of service, the District Management Committee will cancel its qualification as designated medical institutions.

Article 45. If a contestant fails to comply with the management regulations, commits fraud, falsely reports and impersonates himself, after investigation, in addition to recovering the lost funds, the whole region will notify him, and at the same time, he will be disqualified from participating in the current year and the following year.

Chapter X Supplementary Provisions

Forty-sixth this scheme is responsible for the interpretation of the new rural cooperative medical management committee.

Article 47 This scheme shall come into force as of the date of promulgation, and the trial period is tentatively set at one year.