I. Financing standard

In p>21, the financing standard of our county was 13 yuan/person, in which the central government subsidized 6 yuan/person, the local government subsidized 5 yuan/person, and individual farmers paid 2 yuan/person.

II. Fund allocation and use

(I) Fund allocation

In p>21, the new rural cooperative medical system funds were all co-ordinated funds, which were divided into outpatient co-ordinated funds, inpatient co-ordinated funds and risk funds.

1. outpatient co-ordination fund. 3% of the total fund in that year. That is, according to the standard of 39 yuan/person of the total number of participating farmers. The outpatient co-ordination fund is used to pay the general outpatient expenses and health examination expenses of participating farmers in designated medical institutions.

2. Hospitalization pooling fund. According to the extraction of 6% of the total fund in that year, that is, according to the standard of the total number of farmers participating in 78 yuan/person. The hospitalization pooling fund is used to compensate the medical expenses of farmers and the outpatient expenses of chronic special diseases.

3. Risk fund. According to the extraction of 1% of the total amount of the overall fund in that year, the extraction of risk funds will not continue after reaching 1% of the total amount of the overall fund in that year. It is used to make up for the temporary turnover difficulties of the fund caused by abnormal overexpenditure of the fund.

(II) Scope of Fund Use

Fund expenditures should be implemented in accordance with the items and standards stipulated in the Financial System of New Rural Cooperative Medical Fund and other related systems of the new rural cooperative medical system, and the funds required for public health services such as planned immunization, preventive health care and health education (chronic disease survey) should not be included in the scope of fund expenditures. No department, unit or individual may increase expenditure items and raise compensation standards at will.

iii. outpatient co-ordination reimbursement

(I) object of outpatient co-ordination reimbursement

all the outpatient medical expenses incurred by participating farmers in designated medical institutions in the county in that year can enjoy the outpatient co-ordination reimbursement policy of the new rural cooperative medical system.

(II) Proportion of reimbursement for outpatient co-ordination and capping line

There is no deductible line for outpatient co-ordination compensation, and the proportion of compensation for participating farmers seeking medical treatment in outpatient co-ordination designated medical institutions is 4%. The capping line is based on individuals, and the cumulative capping 4 yuan/person year is one year.

(3) the scope of overall reimbursement for outpatient service

1. All western medicines, Chinese medicines, Chinese patent medicines and medical expenses listed in the new rural cooperative medical system can be reimbursed.

2. The scope of non-reimbursement stipulated in the Scope of Basic Diagnosis and Treatment Services of New Rural Cooperative Medical System in Sichuan Province, and the part of outpatient cumulative reimbursement exceeding the top line are all non-reimbursement scope.

(4) Overall reimbursement for outpatient service

After attending a designated medical institution, participating farmers will submit reimbursement to the township health center where their registered permanent residence is located with their cooperative medical certificate, household registration book or ID card, outpatient prescription and outpatient invoice of designated medical institution (including designated pharmacy). Outpatient reimbursement compensation funds shall be paid in advance by designated medical institutions, and all outpatient compensation shall be completed before December 31, 21, and no compensation will be made after the expiration.

IV. Compensation for reimbursement for hospitalization

(I) Scope of reimbursement

1. Drug expenses: implemented according to the Catalogue of Drugs for New Rural Cooperative Medical Care in Sichuan Province (No.97 [21] of Sichuan Health Office).

2. diagnosis and treatment items: according to the catalogue of new rural cooperative medical service items in dazhu county in 21 (formulated according to the scope of diagnosis and treatment services of new rural cooperative medical service items in Sichuan province).

3. medical materials: materials corresponding to medical services according to the scope of diagnosis and treatment services of new rural cooperative medical care in Sichuan province (Sichuan Health Office [25] No.31), all single varieties below 2 yuan are included in the scope of reimbursement, with 2 yuan -1 yuan paying 2% (including 2 yuan) and 1 yuan-2, yuan paying 4% (including 1 yuan). The designated medical institutions in this county shall report the catalogue of medical materials of our hospital to the new rural cooperative medical system for the record.

4. the price of medical services shall be subject to Dazhou medical service price (for trial implementation).

5. The expenses beyond the scope of the drug list and medical diagnosis and treatment services of designated medical institutions at the county level shall be controlled within 15%. Drugs and treatment items outside the above-mentioned "catalogue" must be used, and patients' opinions should be sought, and patients or their families should sign for approval. Where it is used without the consent of the patient, the reimbursement part shall be borne by the medical institution.

(2) hospitalization deductible, Reimbursement ratio and capping line

medical institutions

deductible line

compensation ratio

capping line

township-level designated medical institutions in Dazhou

7%

5,

county-level designated medical institutions in Dazhou

2

55%

. Where a mutual recognition agreement of medical institutions is signed between cities and counties, the reimbursement standard can be implemented according to the reimbursement ratio of medical institutions at the county and township levels. The maximum capping line of the accumulated reimbursement compensation (including hospitalization compensation and special outpatient compensation for major chronic diseases) actually obtained by each participating farmer per year shall not exceed 5, yuan. Under the premise of not exceeding the maximum compensation limit, the actual compensation ratio should not be less than 2% of the total cost.

(3) Other compensations

1. Hospital childbirth allowance. Normal delivery pregnant women in hospital shall be given a fixed subsidy, and the maximum subsidy shall not exceed that of 4 yuan, and they shall no longer enjoy reimbursement according to their diseases. Caesarean delivery is compensated according to the hospitalization compensation standard. Those who enjoy the rural maternity project subsidy shall first receive the project subsidy and then report to the new rural cooperative medical system, but the reimbursement amount of the new rural cooperative medical system plus the project subsidy amount shall not exceed the total invoice amount.

2. Compensation for expenses of traditional Chinese medicine. The participating patients took pure Chinese medicine during hospitalization, and the compensation standard rose by 1%.

3. Patients who have been bitten by dogs and injected with rabies vaccine are no longer included in the quota compensation scope of the new rural cooperative medical system.

4. reimbursement of neonatal hospitalization expenses. Pregnant women can pay the participation funds for their unborn children in advance, and they can enjoy the relevant policies of the new rural cooperative medical system from the date of birth; Medical expenses incurred by newborns who have not participated in the new rural cooperative medical system due to illness are no longer included in the reimbursement scope of the new rural cooperative medical system.

5. participating women and children who are hospitalized in medical institutions at or above the county level will no longer enjoy the preferential compensation policy of 3%.

6. The reimbursement for inpatients with mental illness will be implemented according to the reimbursement scheme of medical institutions, and they will no longer enjoy preferential policies.

7. Newborn disease screening expenses are included in the compensation category of the new rural cooperative medical system, and they are reimbursed according to the proportion, so they no longer enjoy the 5 yuan fixed compensation.

8. Accidental injury hospitalization compensation. Accidental injuries occurred to the participating farmers in their daily life and labor. If the participating farmers can provide reliable evidence to prove that no one else is responsible, they should be included in the scope of compensation. Accidental injury compensation should be publicized in the office of the village (neighborhood) Committee where the patient's household registration is located for 1 month. After publicity, there is no objection, or after investigation and confirmation, the compensation can be paid. Hospitalization expenses for accidental injuries that cannot provide reliable evidence to prove the responsibility of other parties cannot be reimbursed.

9. Farmers who have participated in both the new rural cooperative medical system and commercial medical insurance can apply for compensation in the new rural cooperative medical system with hospitalization invoices, expense lists, copies of discharge certificates (which must be stamped by insurance companies) and insurance company statement documents. The compensation treatment is the same as that of participating farmers who have not participated in commercial medical insurance. At present, migrant workers and school students who participate in two kinds of medical insurance sponsored by the government can enjoy two compensations, but when the second compensation is handled by the new rural cooperative medical system, only the reimbursable balance after the first compensation is reviewed and compensated.

1. The information provided by the participating farmers when they submit their accounts should be original (except those submitted to the insurance company and the medical insurance bureau first).

v. outpatient compensation for major chronic non-inpatient diseases

1. compensation scope. Uremia, malignant tumor, leukemia, tuberculosis (patients treated by all levels of CDC), liver cirrhosis (decompensation), diabetes, psychosis, chronic rheumatic heart disease, cerebrovascular accident recovery period, and hypertension above grade 2.

2. Identification procedure. Participants who have been identified by the county new rural cooperative medical service center in 29 as suffering from major chronic non-hospitalization diseases (the newly diagnosed pulmonary tuberculosis patients in 29 do not need to apply for a chronic disease card) should apply for a chronic disease card with a 1-inch color photo, a resident ID card and a cooperative medical card at the township joint medical office where the household registration is located. In 21, farmers who need long-term outpatient medication due to major chronic non-hospitalization diseases (except tuberculosis patients) should go to the designated medical institution of the county new rural cooperative medical service center with 3 1-inch color photos, resident ID cards and cooperative medical certificates (hypertension is checked by the central hospitals, and mental illness is checked by Dazhou Minkang Hospital and Kangning Clinic. Seven diseases, such as uremia, malignant tumor, leukemia, cirrhosis, diabetes, chronic rheumatic heart disease and cerebrovascular accident, were examined by Dazhu County People's Hospital and Dazhu County Traditional Chinese Medicine Hospital, and I applied to the hospital to fill out the Approval Form for Major Chronic Non-inpatient Diseases of New Rural Cooperative Medical System in Dazhu County (in duplicate), and attached the relevant inspection report. Then I applied to the county new rural cooperative medical service center (the information was submitted by the central hospitals), and the county new rural cooperative medical system was approved by the hospital. In 21, the tuberculosis patients who participated in the project should apply for and fill out the Approval Form for Major Chronic Non-inpatient Diseases of New Rural Cooperative Medical System in Dazhu County with 3 1-inch color photos, resident ID cards and cooperative medical certificates, and fill out and issue chronic disease cards after examination and diagnosis. The compensation time is calculated from the date of diagnosis. The drugs used by designated medical institutions for the diagnosis and treatment of major chronic diseases of participating farmers and the diagnosis and treatment projects implemented must be necessary for the treatment of this disease, and the attached prescriptions and invoices shall be issued.

3. Compensation standard. Three diseases, such as hypertension, mental illness and diabetes, are reimbursed by 7%, and the total compensation cost shall not exceed that of 6 yuan; Four diseases, such as tuberculosis, liver cirrhosis, chronic rheumatic heart disease and cerebrovascular accident, shall be reimbursed at 7%, and the total compensation cost shall not exceed that of 1 yuan. Leukemia, uremia (outpatient expenses other than outpatient dialysis expenses) and malignant tumor (outpatient expenses other than outpatient radiotherapy and chemotherapy) shall be reimbursed by 7%, and the total compensation expenses shall not exceed 3, yuan. Uremia (limited to outpatient dialysis expenses) and malignant tumor (limited to outpatient radiotherapy and chemotherapy expenses) are reimbursed by 45% in the county and 35% outside the county. The accumulated maximum reimbursement limit for individuals (including hospitalization reimbursement for the whole year) is 5, yuan. If the participating patients suffer from more than two diseases, they shall be compensated according to the disease with the highest compensation standard.

4. compensation methods. Outpatient medical expenses for major chronic diseases must be compensated by the township joint medical office where the household registration is located before December 31, 21. Mental illness compensation needs to provide outpatient invoices and compound prescriptions from psychiatric hospitals, tuberculosis compensation needs to provide outpatient invoices, compound prescriptions and disposal certificates from all levels of tuberculosis control centers, and other eight major chronic diseases compensation needs to provide outpatient invoices and compound prescriptions from designated medical institutions or designated pharmacies.

5. Annual review of chronic diseases. Ten chronic disease outpatient compensation shall be audited annually, and the township new agricultural cooperatives shall complete the annual review of chronic disease cards in the following year before the end of the year, and the chronic disease outpatients who have not participated or have been cured or died shall cancel their chronic disease cards and cancel their chronic disease reimbursement qualifications.

VI. Advance fund pre-allocation system

In p>21, reimbursement was made by designated medical institutions. Township hospitals with difficulties in cash flow of advance funds may apply to the county-level new rural cooperative medical institutions for pre-allocation of advance funds. The pre-allocated funds shall not exceed the standard of 5 yuan per person according to the number of participants in the jurisdiction. Township hospitals that need to allocate funds in advance should apply in writing and promise to pay compensation only for reimbursement of the new rural cooperative medical system. After the county new rural cooperative medical system service center is summarized and submitted to the county health and financial departments for review, it will be spent from the county new rural cooperative medical system fund expenditure households. Before December 25th of that year, medical institutions must fully refund the pre-allocated funds to the county new rural cooperative medical system fund expenditure households. Units that need to be pre-allocated in the following year shall re-declare and approve according to the above procedures. The units that fail to return the pre-allocated funds on time will not enjoy the pre-allocated policy in the following year, except for deducting them from the hospital reimbursement funds. County-level hospitals, private hospitals designated by the new rural cooperative medical system and designated pharmacies do not enjoy the preferential allocation of funds.

VII. Settlement method of hospitalization compensation

According to the principle of convenience for the masses and simplification of procedures, we insist on reporting immediately after discharge, that is, reporting immediately. After the participating farmers are hospitalized and discharged from the designated medical institutions in the county, the designated medical institutions will first make preliminary examination and advance the compensation for the new rural cooperative medical system according to the regulations, and the patients will only pay the part that should be paid by individuals. Designated medical institutions regularly settle accounts with the county new rural cooperative medical service center every month. The participating farmers who are hospitalized in other places will return to the township hospitals where the accounts are located for reimbursement. The county health bureau and the county new rural cooperative medical service center should strengthen the supervision of the new rural cooperative medical fund, and the township people's governments and relevant departments should strengthen the supervision of the new rural cooperative medical system.

VIII. This scheme will be implemented as of January 1, 21.

March 9, 21

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