Chapter 1 General Provisions Article 1 In order to strengthen and standardize the designated management of medical security in medical institutions, improve the efficiency of the use of medical security funds, and better protect the rights and interests of the insured persons, according to the "People's Congress of the People's Republic of China and These Measures are formulated by laws and regulations such as the Social Insurance Law of the People's Republic of China, the Basic Medical Hygiene and Health Promotion Law of the People's Republic of China, and the Regulations on the Management of Medical Institutions. Article 2 The fixed-point management of medical insurance in medical institutions should adhere to the people's health as the center, follow the principles of basic protection, 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 insurance for insured persons. Provide appropriate medical services. Article 3 The medical security administrative department is responsible for formulating designated management policies for medical institutions, and supervising medical security handling agencies (hereinafter referred to as "handling agencies") in the process of designated application, professional evaluation, negotiation, agreement conclusion, agreement performance, and agreement termination. , designated medical institutions for supervision. The handling agency is responsible for identifying designated medical institutions, signing medical security service agreements (hereinafter referred to as "medical insurance agreements") with designated medical institutions, providing handling services, and conducting medical insurance agreement management and assessment. Designated medical institutions shall abide by medical security laws, regulations, rules and relevant policies, and provide medical services to insured persons in accordance with regulations. Chapter 2 Determination of Designated Medical Institutions Article 4 The coordinating regional medical security administrative department shall determine the resource allocation of designated medical services in the coordinating region based on public health needs, management service needs, medical insurance fund revenue and expenditure, regional health planning, medical institution establishment planning, etc. . Article 5 The following medical institutions that have obtained a medical institution practice license or a traditional Chinese medicine clinic registration certificate, as well as military medical institutions that are qualified to serve the people and have been approved by the military authorities can apply for designated medical insurance:

(1) Comprehensive Hospitals, traditional Chinese medicine hospitals, integrated traditional Chinese and Western medicine hospitals, ethnic medicine hospitals, specialist hospitals, rehabilitation hospitals;

(2) Specialty disease prevention and treatment hospitals (institutes, stations), maternal and child health care hospitals;

(3) Community health service centers (stations), central health centers, township health centers, street health centers, outpatient departments, clinics, health clinics (stations), village clinics (stations);

( 4) Independent first aid centers;

(5) Hospice centers, hemodialysis centers, and nursing homes;

(6) Medical institutions within nursing homes.

Internet hospitals can rely on their physical medical institutions to apply to sign supplementary agreements. The relevant expenses incurred by the medical services they provide that are within the scope of medical insurance payment will be paid by the coordinating regional handling agency and the physical medical institutions they rely on. Provide for settlement. Article 6 Medical institutions applying for medical insurance designation should meet the following basic conditions: (1) Official operation for at least 3 months.

(2) There should be at least one physician who has obtained a physician's practicing certificate, a rural doctor's practicing certificate, or a traditional Chinese medicine (specialty) physician qualification certificate and whose first registration place is in the medical institution.

(3) The main person in charge shall be responsible for the medical insurance work and be equipped with full-time (part-time) medical insurance management personnel; medical institutions with more than 100 beds should have an internal medical insurance management department and arrange full-time staff.

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

(5) Have hospital information system technology and interface standards that meet the medical insurance agreement management requirements, achieve effective docking with the medical insurance information system, and transmit all patient-related information to the medical insurance information system as required to provide insurance for insured persons Provide direct online settlement. Establish a basic database of medical insurance drugs, diagnosis and treatment items, medical service facilities, medical consumables, disease types, etc., and use national unified medical insurance codes in accordance with regulations.

(6) Comply with laws, regulations and other conditions stipulated by the medical security administrative departments at the provincial level and above. Article 7 When a medical institution submits an application for designated medical insurance to the coordinating regional agency, it must provide at least the following materials:

(1) Designated medical institution application form;

(2) Medical institution practice A copy of the license or TCM clinic registration certificate or the military medical institution’s civilian service license;

(3) The text of the internal management system and financial system corresponding to the medical insurance policy;

( 4) Materials related to the information system of medical institutions related to medical insurance;

(5) Predictive analysis report on the use of medical security funds after inclusion in designated areas;

(6) Provincial medical security Other materials required by the administrative department in accordance with relevant regulations. Article 8 When a medical institution submits an application for a designated location, the coordinating regional agency shall accept it immediately. If the application materials are incomplete, the handling agency will notify the medical institution to make supplements within 5 working days from the date of receipt of the materials. Article 9 The coordinating regional agency should organize an evaluation team or entrust a third-party agency to conduct evaluation in writing, on-site, etc. The members of the evaluation team are composed of professionals in medical security, medicine and health, financial management, and information technology. The evaluation time shall not exceed 3 months from the date of acceptance of application materials, and the time for medical institutions to supplement materials shall not be included in the evaluation period.

The assessment content includes:

(1) Verification of the practice license of medical institutions or the registration certificate of traditional Chinese medicine clinics or the license of military medical institutions to serve the civilians;

(2) Verification of doctors, nurses, Information on the practice of professional technicians such as pharmacy and medical technology and information on the first registration place of physicians;

(3) Verification of diagnosis, treatment, surgery, hospitalization, drug storage and distribution, and inspection and testing that are compatible with service functions Radiation and other infrastructure and equipment;

(4) Verify the internal management system and financial system corresponding to the medical insurance policy, and the results of the review of medical institutions by the health department;

(5) Verify whether the information system of medical institutions related to medical insurance has the conditions for direct online settlement.

The evaluation results are divided into qualified and unqualified. The coordinating regional handling agency shall submit the assessment results to the medical security administrative department at the same level for record. Those that pass the evaluation should be included in the list of medical institutions to be signed and announced to the public. For those who fail to pass the assessment, the reasons should be informed and rectification suggestions should be made. From the date of notification of the results, re-evaluation can be organized after 3 months of rectification. If the evaluation is still unsatisfactory, re-application is not allowed within 1 year.

Provincial medical security administrative departments may formulate specific assessment rules based on these measures and the actual situation.