Liaowei Kiwi women [2011] No.

Notice on the Issuance of the Liaocheng City Pilot Work Implementation Program for Improving the Level of Medical Protection for Rural Children with Major Diseases

Counties (cities, districts) Health Bureau:

In order to effectively do a good job of improving the level of medical protection for rural children with major diseases pilot work, according to the Shandong Provincial Health Department, Civil Affairs Department "on the implementation of the pilot work to improve the level of medical protection for rural children with major diseases implementation of the views" (Lu Wei Nongwei 〔2010〕 No. 9) document, combined with the city's actuality, after the study formulated "Liaocheng City to improve the level of medical protection for rural children with major diseases pilot implementation of the program". The program is hereby issued to you, please conscientiously implement.
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                                                                           Liaocheng City Health Bureau

                                                                                                      March 2, 2011

Liaocheng City Improvement of Rural Children's Medical Care for Major Diseases

Pilot Work Implementation Program to Enhance the Level of Protection for Rural Children with Major Diseases

In order to effectively do a good job of improving the level of medical protection for rural children with major illnesses pilot, according to the Shandong Provincial Health Department, Civil Affairs Department “on the implementation of the pilot work to improve the level of medical protection for rural children with major illnesses implementation of the views” (Lu Wei Agricultural Health 〔2010〕 No. 9) the spirit of the document, combined with the actual situation in our city, the development of this program.

First, the main tasks of the pilot

First of all, in Linqing City, to carry out a comprehensive pilot to improve the level of medical protection for rural children with major illnesses, and according to the fund-raising and use of the situation, sum up the experience, and gradually expand the scope of the pilot in 2011 to more than 50% of the counties (cities, districts), to 2012 in the city's full implementation, and effectively alleviate the economic burden of major illnesses of rural residents.

Second, the pilot disease and treatment objects

Pilot disease types: 1, congenital atrial septal defect (ICD-10: Q21.102), 2, congenital ventricular septal defect (ICD-10: Q21.0), 3, congenital ductus arteriosus (ICD-10: Q25.001), 4, congenital pulmonary valve stenosis (ICD-10: Q22.101), 5, tetralogy of Fallot (ICD-10: Q21.3), 4, congenital pulmonary valve stenosis (ICD-10: Q22.101), 5, tetralogy of Fallot (ICD-10: Q21.3), 4, congenital pulmonary valve stenosis (ICD-10: Q22.101), 5, tetralogy of Fallot (ICD-10: Q21.3), 6, Childhood simple cleft lip (ICD-10:Q36), 7, Childhood acute lymphoblastic leukemia (ICD-10:C91.0), 8, Childhood acute promyelocytic leukemia (ICD-10:C92.4, M9866/3).

Targets of treatment: O to 14 years old (including 14 years old) of the participating children.

Third, designated treatment hospitals

In order to ensure the effectiveness of medical treatment for rural children, according to the pilot disease, the designated medical institutions of the New Rural Cooperative Medical Institutions with diagnosis and treatment conditions, high level of diagnosis and treatment technology, sound rules and regulations, standardized management, and many years of experience in the treatment of related diseases will be selected as the designated hospitals. New rural cooperative designated medical institutions are required to fill in the Liaocheng City Rural Children's Major Diseases Medical Insurance Designated Unit Application Form (see Annex I), and declare according to the authority. Municipal NAC designated medical institutions are required to submit designated applications to the Provincial Department of Health, and the Provincial Department of Health will evaluate and determine the applications. The county-level New Rural Cooperative designated medical institutions with conditions for the treatment of children with acute lymphoblastic leukemia, children with acute promyelocytic leukemia in the middle and late stages, and children with simple cleft lip shall submit designated applications to the Bureau, which shall be evaluated by the Municipal Health Bureau and reported to the Provincial Department of Health for approval and announcement.

IV. Treatment Procedures

(I) Treatment Approval. Suffering from the protection of the disease type of enrolled children, by their parents (guardians) with ID card (hukou), the new rural cooperative card (card) and county and above hospital diagnosis medical records, to the county (city, district) co-management office of the application for treatment and fill out the Liaocheng City, rural children's major illnesses medical insurance approval form (Annex II). The county (city) and district co-management office verifies the identity and condition of the participant, and then determines whether the participant should enjoy the policy of medical protection for children with major diseases. Participating children who are suffering from the guaranteed diseases can enjoy the guarantee policy only if they go to the designated medical institutions with the approval form for rural children's major diseases guarantee.

(ii) Medical treatment. The designated hospitals shall strictly implement the core systems of medical quality and safety, strengthen preoperative discussions and communication between doctors and patients, and fully respect the informed consent and right of choice of the parents of the affected children. Strictly follow the clinical path issued by the Ministry of Health, implement standardized treatment for children, and report the relevant information to the Municipal Health Bureau on a monthly basis (Annex III)

(III) Fee Limits

1、Congenital atrial septal defect RMB 27,000 yuan

2、Congenital ventricular septal defect      

Less than 1 year old (including 1 week old): RMB 50,000 yuan/case

1-3 years old (including 3 years old): RMB 40,000/case

3-14 years old (including 14 years old): RMB 25,000/case

3. Congenital arterial ductus arteriosus CNY

Newborns, small infants (including 3 months): RMB 30,000/case

Greater than 3 months (excluding 6 months): RMB 15,000/case

4、Congenital pulmonary stenosis RMB 30,000 yuan

5、Farrow's tetralogy of Fallot RMB 4 yuan

6、Simple cleft lip in children

Unilateral cleft lip: RMB 3500/case

Bilateral cleft lip: RMB 4100/case

7. Childhood Acute Lymphoblastic Leukemia  

RMB 40,000/case - hospitalization course

8. Acute promyelocytic leukemia in children     

RMB 40,000/case - inpatient course

The fee limit includes bed fee, examination fee, medicine fee, treatment fee, surgery and anesthesia fee, material fee, etc., which is the full cost of disease treatment and is the maximum limit of the fee charged by the designated medical institution, and the designated medical institution is not allowed to charge other fees arbitrarily, and the part of overspending shall be borne by the designated medical institution itself.

(IV) Expense Settlement

Rural children's major disease protection by the coordinating area of the New Agriculture Cooperative on the implementation of the treatment of cases by disease payment, the New Agriculture Cooperative on the pilot disease co-ordination within the scope of the cost of the compensation ratio should reach 70% of the limited cost. The actual amount of compensation for patients who meet the conditions for designated treatment is not subject to the maximum compensation ceiling of the local New Agricultural Cooperative and rural medical assistance. Pilot counties (cities and districts) that have implemented on-site settlement should sign an instant settlement agreement with the relevant designated hospitals for the NPC Children's Major Diseases Medical Insurance, entrusting the designated hospitals to advance compensation funds for patients with major diseases, and the two sides will settle the bill separately within the agreed timeframe. In the pilot counties (cities and districts) where on-site settlement is not implemented, the protected objects will be discharged from the hospital with the “Liaocheng City Rural Children's Major Diseases Medical Insurance Approval Form” signed by the rescue unit, the certificate of discharge settlement, the discharge summary, the total list of expenses, the hospital hospitalization fee settlement statement (original), the cooperative medical certificate, the photocopy of the ID card, and the filing form issued by the New Rural Cooperative Medical Care Management Office in the place where the participants are enrolled to return to their localities for compensation, and to return to the co-ordinating The local cooperative management office will reimburse you.

V. Supporting Measures

(A) pilot counties (cities, districts) to carry out to improve the level of rural children's medical protection of major diseases pilot work into the health care reform objectives, and urgently study the development of a thorough and detailed work program, and timely convene a meeting for deployment. To carry out in-depth publicity and mobilization work for the medical treatment of major illnesses among rural children, and to widely publicize the policy measures for improving the level of medical protection for major illnesses among rural children. It has done a good job of effectively linking the New Rural Cooperative Medical Care and the rural medical assistance system in terms of policy, technology, service management and fee settlement, and has established and improved a synchronized settlement platform. Following the principle of convenience and benefit to the people, optimizing work procedures and improving handling services to ensure that rural children with illnesses receive timely medical treatment.

(ii) Municipal designated hospitals should strengthen their contact with the agreed service areas, set up green channels for receiving treatment cases, standardize the management of admission approvals, and establish complete special files. Strengthen the construction of professional and technical forces, and continuously improve the capacity and level of medical treatment services for major diseases among rural children. A quality control system for the treatment of major diseases in rural children has been established, with strict clinical path management, implementation of core management systems, reasonable control of medical costs, and ensuring medical quality and safety.

(c) Establishing a system for monitoring the quality and cost of medical services, strengthening incentives and restraints, and strengthening the supervision and management of designated hospitals. (d) Give full play to the role of expert groups to improve the quality of project implementation. Formulate performance assessment methods for project implementation, and promote the standardized and orderly operation of project work.

Carrying out the pilot work of improving the level of medical protection for major diseases of rural children is a major initiative to reduce the burden of major diseases on the rural masses, and an important practice to explore the establishment of protection methods for major diseases of rural residents. Localities should attach great importance to seriously organize the pilot work, and make joint efforts to grasp this practical project benefiting the people's livelihood, to ensure that significant results are achieved.

Annex:

First, Liaocheng City, rural children's major diseases medical insurance designated unit application form

Liaocheng City rural children's major diseases medical insurance approval form

Second, Liaocheng City, rural children with major diseases designated treatment registration form

Liaocheng City rural children's major diseases sentinel treatment instant settlement agreement

IV. Statistical table on the implementation of medical treatment for major diseases of children in rural areas by designated hospitals

附件一

聊城市农村儿童重大疾病医疗保障

定点单位申请表

注：申请单位需提供医疗机构执业许可证副本复印件。

附件二

聊城市农村儿童重大疾病医疗保障审批表

Instructions:

1、Three copies of this form, one for each county-level agency, patient and designated medical institution.

2、Patients should provide the original and copy of the diagnosis certificate of the medical institution at or above the county level.

3. The patient shall provide the original and copy of his/her parent's ID card, household register and cooperative medical card.