Measures for the administration of urban and rural medical assistance funds

Measures for the administration of urban and rural medical assistance funds

Chapter I General Principles

Article 1 In order to standardize the management and use of urban and rural medical assistance funds and improve the efficiency of use, these Measures are formulated in accordance with relevant policies and regulations.

Article 2 The term "urban and rural medical assistance fund" as mentioned in these Measures refers to the special funds raised through public budget, lottery public welfare fund and donations from all walks of life, which are used for medical assistance for poor families in urban and rural areas according to regulations.

Third urban and rural medical assistance funds should be managed and used in accordance with the principles of openness, fairness, justice, earmarking and balance of payments.

Article 4 Urban and rural medical assistance funds shall be included in the financial special account of social security fund (hereinafter referred to as the special account of social security fund), and shall be accounted for separately, managed specially and used exclusively. The county-level financial department will merge the "urban medical assistance fund account" and "rural medical assistance fund account" originally set up in the social security fund account, and set up the "urban and rural medical assistance fund account" for fund raising, disbursement and payment. [ 1-2]

Chapter II Fund Raising

Fifth people's governments at or above the county level shall establish urban and rural medical assistance funds, and the sources of urban and rural medical assistance funds mainly include:

(1) urban and rural medical assistance funds shall be arranged by local financial departments at all levels in the public budget and lottery public welfare fund at the beginning of the year according to the actual needs of urban and rural medical assistance work in the region and the relevant provisions of budget management.

(2) Funds donated voluntarily by all sectors of society.

(three) the interest income formed by the urban and rural medical assistance fund.

(four) other funds that can be used for urban and rural medical assistance according to regulations.

Article 6 The financial department at or above the county level shall, jointly with the civil affairs department, scientifically and reasonably arrange the subsidy funds for urban and rural medical assistance according to the needs of urban and rural medical assistance objects, work development and other factors and the financial management system. The higher level finance should give appropriate subsidies to the economically difficult areas. [ 1-2]

Chapter III Utilization of Funds

Seventh urban and rural medical assistance funds for urban and rural residents, rural five guarantees and other people with financial difficulties who meet the conditions of medical assistance.

Article 8 The urban and rural medical assistance fund shall, in combination with the relevant policies and regulations of the basic medical insurance for urban residents and the new rural cooperative medical system (hereinafter referred to as the basic medical insurance), make overall consideration of the assistance needs of the needy people in urban and rural areas. One is to ensure that all recipients participate in basic medical insurance, and the other is to subsidize the medical expenses that recipients can't afford after being compensated by basic medical insurance, serious illness insurance and commercial insurance, so as to help people in need get basic medical services. For those who are unable to participate in the basic medical insurance for various reasons, they can be directly given assistance at their own expense.

Ninth rescue methods are mainly hospitalization, while taking into account outpatient assistance. All localities should scientifically formulate rescue plans, set a reasonable capping line, and steadily improve the level of rescue. It is necessary to coordinate the urban and rural medical assistance system in combination with the basic medical insurance benefits, bridge the difference between urban and rural poor people in obtaining medical assistance, and meet their normal medical service needs.

Tenth areas should be combined with local conditions, clear the specific scope of urban and rural medical assistance, and refine the specific use of urban and rural medical assistance funds. [ 1-2]

Chapter IV Fund Expenditure

Eleventh urban and rural medical assistance funds in principle, the implementation of direct financial payment. The civil affairs department shall apply to the finance department at the same level for funding, and the finance department will directly pay the urban and rural medical assistance funds from the social security fund account to the designated medical institutions, designated retail pharmacies or medical assistance objects.

Medical assistance objects insured, by the civil affairs department to the finance department at the same level to provide basic medical insurance agencies to confirm the number of medical assistance objects, insurance participation financing standards and the total amount of funds, after the audit of the finance department at the same level, the individual contributions from the social security fund account special account for urban and rural medical assistance funds allocated to the special account for urban residents' basic medical insurance or special account for new rural cooperative medical care.

In areas where "one-stop" real-time settlement is implemented, designated medical institutions and retail pharmacies deduct basic medical insurance reimbursement expenses and medical assistance subsidy expenses at the time of settlement, and the insured participants only need to settle the part that the individual should bear. Medical assistance funds advanced by basic medical insurance agencies, designated medical institutions and designated retail pharmacies shall be reported to the civil affairs department for examination and approval within the specified time, and the civil affairs department shall apply to the financial department at the same level for payment, and the financial department at the same level shall pay directly to the above-mentioned institutions through the "special account for urban and rural medical assistance funds".

In areas where "one-stop" instant settlement has not been implemented, and those who need assistance afterwards, the individual of the medical assistance object shall, in accordance with the regulations, issue an audit or settlement form for reimbursement of basic medical insurance, a compound prescription of a designated medical institution or an invoice for drug purchase from a designated retail pharmacy, and other valid documents that can prove the compliance of medical expenses, and report them to the civil affairs department at the same level for examination and approval within the specified time. The civil affairs department shall apply to the financial department at the same level, and the financial department at the same level shall, in principle, directly pay the medical assistance object through the "special account of urban and rural medical

The civil affairs department of the overall planning area can provide a certain amount of prepaid funds to the designated medical institutions through direct financial payment, and reduce the hospitalization deposit of the relief object to facilitate its medical treatment.

Twelfth regional civil affairs departments that do not have direct payment conditions can open urban and rural medical assistance fund expenditure households (hereinafter referred to as expenditure households) as needed. A co-ordination area can only open one expenditure account at most. In areas where all medical assistance subsidies are directly subsidized, there are no expenditure households.

The main purpose of the expenditure account is to receive the funds allocated from the financial special account and pay the fund expenditures, including medical expenses subsidies that cannot be settled in one stop, fund expenditures in remote areas such as underdeveloped financial services and areas that do not have direct payment conditions, and other fund expenditures that can be directly paid to the recipients according to the policy. Interest income of expenditure households should be paid into the special account of social security fund on a regular basis and included in the management of urban and rural medical assistance funds.

Spending households shall not engage in other businesses except paying medical expenses to designated medical institutions and retail pharmacies and paying relief funds to medical aid recipients. In principle, cash expenditure is gradually reduced and cancelled by means of transfer.

Thirteenth to establish a regular reconciliation system, local financial and civil affairs departments at all levels should conscientiously do a good job in cleaning up and reconciliation of urban and rural medical assistance funds in accordance with the regulations, not less than twice a year. At the end of the year, the civil affairs department shall submit the annual implementation of urban and rural medical assistance funds and related explanations to the financial department at the same level as required. [ 1-2]

Chapter V Fund Management

Fourteenth urban and rural medical assistance fund year-end balance funds can be carried forward to the next year to continue to use. The accumulated balance of the fund generally does not exceed 15% of the total amount of funds raised in the current year. All localities should further improve the rescue plan, ensure the balanced and rational use of funds, and ensure that the recipients can benefit to the maximum extent.

Fifteenth urban and rural medical assistance funds must be used for medical assistance to the relief object, and the urban and rural medical assistance funds will not be settled for medical expenses incurred by not using drugs, not providing medical services according to regulations. No unit or individual may intercept, occupy or misappropriate, and may not charge any management fee to the relief object.

Article 16 the collection and use of urban and rural medical assistance funds shall be announced to the public through websites, announcements and other forms every quarter, and the objects of urban and rural medical assistance and the amount of assistance shall be posted on the village (neighborhood) committees every quarter, subject to social supervision.

Article 17 Civil affairs departments shall, jointly with human resources and social security, health and family planning departments, regularly check the medical services and charges of designated medical institutions and retail pharmacies, and suspend or stop the disbursement of funds advanced by them if the quality of medical services is poor or medical acts are illegal.

Eighteenth local civil affairs and financial departments at all levels should regularly supervise and inspect the use of urban and rural medical assistance funds, and consciously accept the supervision of auditing and supervision departments. The Ministry of Civil Affairs and the Ministry of Finance conduct spot checks on the development of medical assistance work and the use of funds in various places.

Article 19 Units and individuals who falsely report such violations as impersonation, misappropriation, corruption and waste will be dealt with severely in accordance with relevant laws and regulations. Those who deliberately fabricate false information to defraud higher-level subsidy funds shall be ordered to immediately correct, deduct and stop allocating higher-level subsidy funds, and the responsibilities of relevant units and personnel shall be investigated according to regulations. [ 1]

Chapter VI Supplementary Provisions

Twentieth local financial and civil affairs departments can formulate specific measures for the management of urban and rural medical assistance funds according to local actual conditions.

Article 21 These Measures shall come into force as of the date of issuance, and the Opinions of the Ministry of Finance and the Ministry of Civil Affairs on Strengthening the Management of Urban Medical Assistance Funds (No.39 [2004] of Caishe/KLOC-0) shall be abolished at the same time.

Article 22 These Measures shall be interpreted by the Ministry of Finance and the Ministry of Civil Affairs.