Changsha medical assistance implementation rules, who can get?

2022-05-25 0 By

Medical care is an important part of people’s livelihood. Recently, The Implementation Rules of Changsha Medical Assistance were issued to care for citizens from the aspect of medical assistance.Recently, the Changsha Municipal government published a notice on its website on printing and distributing the Implementation Rules of Changsha Medical Assistance (hereinafter referred to as the Rules).The Rules clearly define the recipients of assistance, the standards of assistance, and the procedures for post-assistance and re-assistance, effectively preventing citizens from falling back into poverty due to illness.The rules take effect from the date of publication, can be dated to January 1, 2022, and are valid for five years.The following persons who enjoy the treatment of basic medical insurance as specified in the Detailed rules and who have a resident registration in the city and still have difficulties after their medical expenses are paid by basic medical insurance, serious disease insurance and other supplementary medical insurance may apply for medical assistance in accordance with the provisions of these Detailed rules.Category I relief objects include people in extreme poverty, orphans, and children who have no one to support them (hereinafter referred to as Category I relief objects);The second category is the recipients of the minimum living allowance, the severely disabled, the marginal family members of the minimum living allowance, and the monitoring objects of the prevention of returning to poverty (hereinafter referred to as the second category).The third category of recipients are those who do not meet the requirements of the first and second categories of recipients, but have serious difficulties in basic family life due to high medical expenses (hereinafter referred to as the third category of recipients).Those who are not registered permanent residence in the city but belong to the first or second class aid objects identified by the city shall be included in the scope of medical aid in the City.The third type of relief objects to apply for medical assistance, in principle, one should meet the following criteria: health care to census register seat departments apply for medical assistance before 12 months of household disposable income per capita is low, in addition to the basic housing, basic necessities of the family property is insufficient to cover medical expenses is proud part of critically ill patients.Seriously ill patients whose medical expenses within the scope of individual annual medical insurance policies amount to more than 50% of their family’s total annual disposable income and are impoverished due to illness.Medical treatment outside the city or region without proper reasons without referral procedures is not included in the relief “Detailed Rules” clearly, the scope of medical assistance payment includes: after the aid recipients are reimbursed by basic medical insurance, serious disease insurance, supplementary medical insurance, etc., self-financed expenses in line with the scope of payment of basic medical insurance policies;The burden of medical expenses for rare diseases included in the scope of medical security stipulated by the state (including the medical expenses necessary for the maintenance of diagnosis and treatment within the scope of the basic medical insurance policy and the cost of special drugs for rare diseases).The following medical expenses shall not be included in the scope of relief: the medical expenses incurred by medical institutions with non-basic medical insurance agreements, the cost of purchasing drugs, or the medical expenses incurred by medical institutions outside the city or region without proper reasons and without referral procedures.Medical expenses incurred in health care, plastic surgery and cosmetology.Medical expenses such as traffic and medical accidents shall be paid by a third party according to law.Other circumstances stipulated by laws, regulations and policies.The rules clearly states that the hospitalization of the aid recipients is within the scope of the medical assistance policy payment, and the part of the self-funded medical expenses that reach the annual accumulative amount above the relief threshold payment line and less than 100,000 yuan will be provided with a certain proportion of the assistance.The first category of aid recipients: there is no payment line and 90% of the aid shall be given.The second category of relief objects: the threshold payment line is determined by 5% of the per capita disposable income of the residents of Hunan province in the previous year, and the threshold payment line is determined by 1500 yuan in 2022, and then dynamically adjusted according to the actual situation.The part above the threshold payment line shall be bailed out at a ratio of 70%.The third category of relief objects: The threshold payment line is determined in principle by 25% of the per capita disposable income of the residents of Hunan province in the previous year. The threshold payment line in 2022 is determined to be 7,300 yuan, and then dynamically adjusted according to the actual situation.The part above the threshold payment line shall be provided with 50% assistance.For those ex-servicemen in difficulty who are the recipients of aid in category I, II and III, within the annual limit of aid, they shall be given aid at a rate of 10% higher than the standard of aid for similar people in difficulty.For those who need long-term medication for chronic diseases and long-term out-patient treatment for serious or very serious diseases, the individual out-patient medical expenses are higher, and the amount of the above part of the aid standard shall be provided in a certain proportion.Outpatient assistance for special diseases.Assistance shall be provided in accordance with the scope of outpatient diseases of special diseases, and the annual accumulative limit of assistance shall not exceed RMB 8,000.There is no threshold for the recipients of the first category of assistance, and 90% of their own medical expenses within the annual limit will be subsidized.The second type of relief object starting payment line is 1000 yuan, the annual limit of the individual self-financing medical expenses in accordance with 50% of the proportion of relief.Outpatient medical assistance for major diseases.Those who suffer from serious diseases and need long-term out-patient treatment shall be subject to the standards for inpatient medical assistance for the corresponding categories of recipients and be included in the annual accumulative limit of inpatient medical assistance.Disease of medical treatment of outpatient service of serious and very big disease is planted: malignant tumor outpatient service puts chemotherapy, uremia didialysis, organ transplanting hind fights rejection cure, drug of patient of heavy sex mental disease maintains cure, diabetic insulin cure, tuberculosis, hemophilia, and other by the country, province medical treatment security bureau clear disease is planted.If the aid recipients have multiple status types of difficulties, the aid shall be provided in accordance with the principle of “higher treatment”.Aid program to prevent happen again due to illness Chinese poverty “detailed rules” clear, the first class and second class rescue object identity of his own identity card and the relevant materials to the difficult is located in the county “one-stop” settlement fixed-point medical institutions for medical treatment, enjoy treatment of medical treatment directly, should the cost paid by the medical rescue funds, by the agreement of medical institutions in accordance with the provisions of the basic medical insurance immediate settlement.”One-stop” settlement can be implemented for those who need to be transferred to another hospital due to their illness or who seek medical treatment within the city area after standardized referral.In the month when the medical security department settles accounts with the designated medical institution, the medical assistance result of “one-stop” settlement shall be timely publicized on the fixed billboard of the villagers’ committee (community residents’ committee) in the place where the relief object is located. The publicity period is 5 working days and the result shall be subject to social supervision.The post-aid objects and applicable circumstances are: the third aid objects, the first or second aid objects who go outside the city or region for medical treatment, and other circumstances in which “one-stop” settlement cannot be implemented.Of basic medical insurance, serious illness insurance and medical treatment system of triple pay, and medical aid to reach the annual quotas, the policy within the scope of personal medical expenses exceed 25% of last year’s per capita disposable income of hunan province, and there are Chinese poverty risk, according to the proportion of 50% for help again, prevent illness Chinese poverty.The detailed rules emphasize that in the process of re-assistance, if a patient with a sudden serious disease is encountered, relevant departments should handle the case on a special basis and timely review.Source | Xiaoxiang Morning News editor | Li Xufeng proofread | He Zhiping reviewer | Qin Huiying