National Health Insurance Administration: Medical institutions meet these 6 conditions can apply for fixed-point

Pharma Network January 14 - Recently, the State Health Insurance Administration issued the Interim Measures for the Administration of Medical Security In Medical Care, which will come into effect on February 1, 2021.
of these organizations can apply for fixed points and what conditions need to be met? The communes of primary physicians organize the following: These types of institutions can apply for medical insurance fixed-point one, general hospital, Chinese medicine hospital, Chinese and Western medicine combined hospital, ethnic medicine hospital, specialized hospital, rehabilitation hospital; Stations), central health hospitals, township hospitals, street health hospitals, outpatient clinics, clinics, health clinics (stations), village health rooms (stations);
Internet hospital may apply for a supplementary agreement on the basis of its entity medical institutions, and the related expenses arising from the medical services provided by it in accordance with the scope of medical insurance payment shall be settled in accordance with the provisions of the entity medical institutions on which it relies.
To apply for medical insurance, six conditions must be met, one, the official operation for at least 3 months; Set up internal medical insurance management department, arrange full-time staff, fourth, have the medical insurance management system, financial system, statistical information management system, medical quality and safety core system, etc., and fifth, have the hospital information system technology and interface standards that meet the medical insurance agreement management requirements, realize effective docking with the medical insurance information system, transmit all relevant information to the medical insurance information system according to the requirements, and provide direct network settlement for the insured personnel.
Establish basic databases on medical insurance drugs, medical treatment projects, medical service facilities, medical supplies, diseases and other diseases, and use the unified national medical insurance code in accordance with the provisions;
Submit a fixed-point application for medical insurance, these materials must be one, fixed-point medical institutions application form, second, medical institutions license or Chinese medicine clinic record certificate or military medical institutions for the civilian service license copy; third, the internal management system corresponding to the medical insurance policy and financial system text; fourth, medical insurance-related medical institutions information system related materials; fifth, included in the fixed-point use of medical security funds forecast analysis report; sixth, provincial medical security administrative departments in accordance with the relevant provisions of other materials.
After accepting the application materials, it is necessary to evaluate these contents, first, to verify the license of medical institutions or the record certificate of Chinese medicine clinics or the license of military medical institutions to serve the people; Adapted diagnostic, therapeutic, surgical, hospitalization, drug storage and distribution, examination and inspection of radiation and other infrastructure and equipment; fourth, verification of the internal management system and financial system corresponding to the medical insurance policy, the results of the medical institutions in the health and health departments, fifth, verification of medical institutions related to medical insurance information systems are qualified to carry out direct network settlement.
assessment results are classified as qualified and unqualified.
the administrative department of medical security at the same level shall report the results of the assessment to the administrative department of medical security at the same level for the record.
for the assessment of qualified, it shall be included in the list of medical institutions to be signed an agreement, and made public to the public.
if the assessment is not qualified, it shall inform it of the reasons and make suggestions for rectification.
the date of delivery of the results, after 3 months of rectification, the evaluation may be re-organized, the assessment is still not qualified, and may not be re-applied within 1 year.
provincial medical security administrative departments may, on the basis of these Measures, formulate specific assessment rules according to the actual situation.
If one of the following circumstances occurs, it shall not accept fixed-point, non-essential medical services such as medical beauty, assisted reproduction, life care, dental implantation as the main scope of practice
If the legal liability for administrative punishment has not been fully fulfilled for a year; 6. If the agreement has been lifted for a serious violation of the medical insurance agreement for not more than one year or has been fulfilled for one year but has not fully fulfilled the responsibility for breach of contract; 7. The legal representative, the principal person in charge or the actual controller has been discharged from the medical insurance agreement at the original point due to serious violations of the law and regulations, for a term of not more than 5 years; and the legal representative, the principal person in charge or the actual controller has been included in the list of persons who have failed to comply with the law; and the other cases stipulated in the laws and regulations shall not be accepted.
Institutions that have the following acts will be dissolved from the medical insurance agreement, which means that the medical insurance agreement between the operating institution and the designated medical institution is lifted, the agreement relationship no longer exists, the medical expenses incurred after the agreement is lifted, and the medical security fund is no longer settled.
If a fixed-point medical institution has one of the following circumstances, the administrative institution shall lift the medical insurance agreement and publish to the society the list of medical institutions that have lifted the medical insurance agreement: First, the medical insurance agreement has been suspended 2 times or more during the validity period of the medical insurance agreement or the suspension of the medical insurance agreement has not been corrected or not in place as required; 4. Providing settlement of medical insurance expenses for non-fixed-point medical institutions or medical institutions during the suspension of medical insurance agreements; 5. Refusing, obstructing or not cooperating with medical security departments in carrying out intelligent audits, performance appraisals, supervision and inspection, etc., if the circumstances are serious; 6. If significant information changes are found but no major information changes are made; 7. If the fixed-point medical institutions are closed or closed, they are not reported to the operating institutions in accordance with the provisions; If a designated medical institution is found to have committed a major violation of the law and may cause a major loss of the medical security fund; 9, revoked or cancelled the medical institution's license to practise or to file a certificate with a Chinese medicine clinic; 10. The legal representative, the principal person in charge or the actual controller cannot fulfill the medical insurance agreement agreement, or has committed illegal and breach of trust; 10 1. Failure to comply with the administrative penalty decision made by the administrative department of medical security in accordance with the law; 12, if the designated medical institution voluntarily proposes to terminate the medical insurance agreement and the administrative body agrees; 13. If the medical insurance agreement shall be lifted in accordance with the medical insurance agreement; and 14. Other circumstances that should be lifted as stipulated in laws, regulations and regulations.