Chapter I General Provisions Article 1 In order to strengthen and standardize the fixed-point management of medical insurance in medical institutions, improve the efficiency of the use of medical insurance funds and better protect the rights and interests of insured persons, these Measures are formulated in accordance with the Social Insurance Law of People's Republic of China (PRC), the Basic Medical Care and Health Promotion Law of People's Republic of China (PRC) and the Regulations on the Administration of Medical Institutions. Article 2 The fixed-point management of medical insurance in medical institutions shall adhere to the people's health as the center, follow the principles of basic security, fairness and justice, clear rights and responsibilities, and dynamic balance, strengthen the refined management of medical insurance, promote the supply-side reform of medical institutions, and provide appropriate medical services for the insured. Article 3 The administrative department of medical security shall be responsible for formulating the fixed-point management policies of medical institutions, and supervising the medical security agencies (hereinafter referred to as "agencies") and designated medical institutions in the aspects of fixed-point application, professional evaluation, negotiation, agreement conclusion, agreement performance and agreement dissolution. Agencies are responsible for determining designated medical institutions, signing medical security service agreements with designated medical institutions (hereinafter referred to as "medical insurance agreements"), providing handling services, and managing and assessing the medical insurance agreements. Designated medical institutions shall abide by the laws, regulations, rules and relevant policies of medical security and provide medical services for the insured in accordance with the provisions. Chapter II Determination of Designated Medical Institutions Article 4 The administrative department of medical security in the overall planning area shall determine the resource allocation of designated medical services in the overall planning area according to public health needs, management service needs, income and expenditure of medical insurance funds, regional health planning and medical institution setting planning. Article 5 The following medical institutions that have obtained the Practice License of Medical Institutions or the Registration Certificate of Chinese Medicine Clinics, as well as military medical institutions that serve the people with the approval of the competent military departments, may apply for designated medical insurance:

(1) General hospitals, traditional Chinese medicine hospitals, integrated traditional Chinese and western medicine hospitals, ethnic medicine hospitals, specialized hospitals and rehabilitation hospitals;

(2) Specialized disease prevention hospitals (stations) and maternal and child health centers;

(3) Community health service centers (stations), central hospitals, township hospitals, street hospitals, out-patient departments, clinics, hospitals (stations) and village clinics (institutes);

(4) Independent emergency center;

(5) Hospice care centers, hemodialysis centers and sanatoriums;

(six) medical institutions set up in the old-age care institutions.

Internet hospitals can rely on their physical medical institutions to apply for signing supplementary agreements, and the related expenses incurred by the medical services provided by them that meet the scope of medical insurance payment shall be settled by the regional agencies and the physical medical institutions they rely on according to regulations. Article 6 A medical institution applying for designated medical insurance shall meet the following basic conditions:

(a) formal operation for at least 3 months.

(2) There are at least 1 person who have obtained the practicing certificate of doctors, the practicing certificate of rural doctors or the practicing qualification certificate of traditional Chinese medicine (specialist) and registered in medical institutions for the first time.

(three) the main person in charge is responsible for the medical insurance work, equipped with full-time (part-time) medical insurance management personnel; /kloc-medical institutions with more than 0/00 beds should set up internal medical insurance management departments and arrange full-time staff.

(4) Having a medical insurance management system, a financial system, a statistical information management system and a medical quality and safety core system that meet the management requirements of the medical insurance agreement.

(5) Having hospital information system technology and interface standards that meet the requirements of medical insurance agreement management, realizing effective docking with the medical insurance information system, transmitting relevant information of all patients to the medical insurance information system as required, and providing direct online settlement for the insured. The establishment of medical insurance drugs, diagnosis and treatment projects, medical service facilities, medical consumables, diseases and other basic databases, according to the provisions of the use of a unified national medical insurance code.

(six) meet other conditions stipulated by laws and regulations and provincial and above medical security administrative departments. Seventh medical institutions to apply for medical insurance designated agencies in the overall planning area, at least provide the following materials:

(a) the designated medical institutions application form;

(2) A copy of the practice license of a medical institution or the registration certificate of a Chinese medicine clinic or the service license of a military medical institution for the people;

(3) Internal management system and financial system that are compatible with the medical insurance policy;

(4) Information system related materials of medical institutions related to medical insurance;

(5) A forecast analysis report on the use of the medical insurance fund after it is included in the designated place;

(six) other materials provided by the provincial medical security administrative department in accordance with the relevant provisions. Eighth medical institutions put forward designated applications, regional agencies shall immediately accept. If the application materials are incomplete, the agency shall inform the medical institution of one-time correction within 5 working days from the date of receiving the materials. Ninth regional institutions should organize an evaluation team or entrust a third party to carry out the evaluation in written and on-site form. The members of the evaluation team are composed of professionals such as medical security, medicine and health, financial management and information technology. From the date of accepting the application materials, the evaluation time shall not exceed 3 months, and the time for medical institutions to supplement the materials shall not be included in the evaluation period. The evaluation contents include:

(1) Examining the Practice License of Medical Institutions or the Registration Certificate of Chinese Medicine Clinics or the License of Military Medical Institutions Serving the People;

(2) Checking the practice information of doctors, nurses and pharmaceutical technicians and the first registration information of doctors;

(three) inspection and service functions to adapt to the diagnosis, treatment, surgery, hospitalization, drug storage and distribution, inspection, radiation and other infrastructure, equipment;

(four) to check the internal management system and financial system corresponding to the medical insurance policy, and the evaluation results of the health department on medical institutions;

(five) check whether the information system of medical institutions related to medical insurance has the conditions to carry out online direct settlement.

The evaluation results are divided into qualified and unqualified. Overall regional agencies should report the evaluation results to the administrative department of medical security at the same level for the record. Those who pass the examination should be included in the list of medical institutions that have signed the agreement and publicized to the public. If the evaluation is unqualified, it shall inform the reasons and put forward rectification suggestions. From the date of delivery of the result notice, the review can be organized again after 3 months of rectification. If the evaluation is still unqualified, you may not apply again within 1 year.

The provincial medical security administrative department may, on the basis of these measures, formulate specific evaluation rules according to the actual situation.