Notice of the Ministry of Human Resources and Social Security, the Ministry of Finance and the Health Commission on Carrying out the Settlement of Work-related Injury Insurance for Cross-provincial and Non-local Medical Treatment

Notice of the Ministry of Human Resources and Social Security, the Ministry of Finance and the National Health Commission on Carrying out the Pilot Work of Direct Settlement of Work-related Injury Insurance for Cross-provincial and Non-local Medical Treatment [2024] No. 11

To the human resources and social security departments (bureaus), finance departments (bureaus), and health commissions of all provinces, autonomous regions, municipalities directly under the Central Government, and the Xinjiang Production and Construction Corps:

In order to accelerate the direct settlement of work-related injury insurance for cross-provincial and non-local medical treatment, better protect the rights and interests of work-related injury employees, and continuously improve the convenience of work-related injury insurance management services and the sense of access of work-related injury employees, according to the Guiding Opinions of the General Office of the State Council on Accelerating the Promotion of "Cross-Provincial General Handling" of Government Services (Guo Ban Fa [2020] No. 35) and the Notice of the Ministry of Human Resources and Social Security on Printing and Distributing <人力资源社会保障信息化便民服务创新提升行动方案>(Ministry of Human Resources and Social Security [2020] No. 83) requires that the pilot work of direct settlement of work-related injury insurance for cross-provincial and non-local medical treatment be carried out. The relevant work is hereby notified as follows:

First, the pilot objectives

On April 1, 2024, the human resources and social security departments (bureaus) of all provinces (autonomous regions and municipalities directly under the Central Government) and the Xinjiang Production and Construction Corps (hereinafter referred to as the province) will select some cities to start the pilot work of direct settlement of work-related injury insurance for cross-provincial and non-local medical treatment, relying on the national work-related injury insurance remote medical treatment settlement information system (hereinafter referred to as the work-related injury insurance remote medical treatment system), and implement the pilot city personnel holding social security cards (including electronic social security cards, hereinafter referred to as social security cards) to directly settle cross-provincial and non-local medical treatment and hospitalization work-related injury medical expenses. Hospitalization work-related injury rehabilitation expenses and assistive device configuration expenses. The pilot period is one year. Through the pilot, the direct settlement system for cross-provincial and non-local medical treatment in the pilot cities has been basically finalized, the mechanism has been running smoothly, the filing of medical treatment in other places is standardized and convenient, and the direct settlement needs of local work-related injured workers for cross-provincial and remote medical treatment have been initially met.

II. Basic Principles

(1) Unified management. Adhere to the unified management of the place of medical treatment, and include remote medical treatment in the scope of various management services such as the management of the agreement of the place of medical treatment, the monitoring of expenses, and the supervision of the quality of medical services.

(2) Convenient settlement. Insist on providing convenient and fast settlement services for employees injured at work, and the payment part of the work-related injury insurance fund shall be paid by the agency at the place of medical treatment and the medical (rehabilitation) and assistive device allocation agency (hereinafter referred to as the agreement institution) in accordance with the agreement after review and payment in accordance with the agreement.

(3) Step by step. Adhere to the inclusion of hospitalization expenses first, starting with long-term residence (work) in other places and referral and transfer personnel in other places, give priority to connecting areas where medical treatment is concentrated in other places, and connect the information systems of agreement institutions one by one, and promote direct settlement work in a steady and orderly manner.

(4) Linkage and joint promotion. Adhere to the combination of clear division of labor and shared responsibility for medical treatment in the place of insurance and medical treatment in other places, establish a scientific and effective coordination mechanism, improve the quality of management services, and ensure that employees with work-related injuries receive high-quality and convenient direct settlement services for medical treatment in different provinces and places.

(5) Safe and sound. Adhere to the work-related injury insurance fund to set income, balance income and expenditure, strictly regulate management, rational use of the fund, effectively prevent risks, and ensure the safe and sustainable operation of the fund and the payment of various benefits. 

3. Clarify the scope of persons seeking medical treatment in other places

Employees who have participated in work-related injury insurance and have completed the work-related injury identification, work-related injury recurrence confirmation, work-related injury rehabilitation confirmation or assistive device allocation confirmation in a non-local place for long-term residence, permanent work in a different place, and referral and transfer in a different place can apply for direct settlement of cross-provincial and non-local medical treatment and hospitalization medical expenses, inpatient work-related injury rehabilitation expenses and assistive device allocation expenses.

(1) Work-related injured employees who have lived (worked) outside the insured province for half a year (inclusive) or more, and meet the requirements for medical treatment, rehabilitation, and assistive device allocation in other places in the insured place.

(2) Employees injured at work who are limited to medical technology and equipment that cannot be diagnosed or equipped with medical technology and equipment, and meet the requirements for referral and transfer in the insured place.

4. Clarify the policy of seeking medical treatment in other places

(1) Strict record management. Before an injured employee seeks medical treatment across provinces and places, he or she shall file with the handling agency of the place where he or she participates in the insurance and obtain review and approval. The validity period for the filing of long-term residence (work) work-related injuries in other places and inter-provincial referral and hospital transfers shall be uniformly stipulated by the province where the insured place is located (hereinafter referred to as the insured province). The insured province shall guide the long-term residence (work) work-related injury employees in other places to seek medical treatment in an orderly manner, and may reasonably set the time limit requirements for changing or canceling the record, which shall not exceed 6 months in principle.

(2) Clarify the scope of settlement. The inpatient work-related injury medical expenses, inpatient work-related injury rehabilitation expenses and assistive device allocation expenses incurred by employees with work-related injuries in other places without third-party liability are included in the scope of direct settlement for cross-provincial and non-local medical treatment. The in-hospital meal subsidy and the transportation, food and lodging expenses required for medical treatment outside the co-ordination area due to non-local referral and transfer are not included in the scope of direct settlement for cross-provincial and non-local medical treatment, and shall be reviewed and reimbursed by the handling agency of the insured place in accordance with the policy of the insured place.

(3) Standardize treatment policies. For inpatient work-related injury medical expenses and inpatient work-related injury rehabilitation expenses directly settled for medical treatment in other places, the relevant provisions of the catalogue of work-related injury insurance diagnosis and treatment items, the catalogue of work-related injury insurance drugs, the work-related injury insurance inpatient service standards, and work-related injury rehabilitation service items shall be implemented, and the relevant provisions of the catalogue of assistive devices in the place of insurance shall be implemented for the allocation of assistive devices.

If a person who lives (works) in another province or another place or seeks medical treatment in another place within the validity period of the record, he or she shall enjoy the work-related injury insurance cost settlement service in the place of medical treatment and implement the policy of the place of medical treatment; During the validity period of the record, employees who are injured at work can receive multiple medical treatment at the place of medical treatment and enjoy the direct settlement service for medical treatment in different provinces and places.

5. Strengthen the management of medical treatment in other places

(1) Rational layout of non-local agreement institutions. In accordance with the principle of rational layout and step-by-step inclusion, all provinces should select cities where the medical needs of injured workers are more concentrated, and the management service level and informatization degree are relatively high. Each province chooses to determine the number of prefectures and cities to carry out the pilot project of direct settlement of cross-provincial and non-local medical treatment for work-related injury medical treatment, and controls it within 40% of the total number of prefectures and cities in the province. The pilot cities shall determine the corresponding agreement medical institutions in the city according to the actual situation, and gradually increase them according to the progress of the pilot work. During the pilot period, each province will choose to determine at least one agreement rehabilitation institution and one assistive device allocation institution to realize the online direct settlement of medical expenses in different places.

(2) Implement unified management of the place of medical treatment. The handling agency of the place where medical treatment is provided shall include the injured employees who seek medical treatment in other places into the local unified management, provide them with the same services and management as the local injured employees, and include the relevant data in the local statistical analysis. The handling agency of the place of medical treatment shall include the work of seeking medical treatment in other places into the scope of management of the agreement, and clarify the relevant content in the agreement. It is necessary to strengthen the management of fund expenditures, and supervise the agreement institutions to strictly implement the relevant provisions of the catalogues and standards of work-related injury insurance by carrying out daily inspections, special inspections, annual inspections, etc., and make full use of the inspection results in the renewal of agreements and monthly settlements.

6. Standardize the process of seeking medical treatment in other places

(1) Standardize the transfer-out process. Before an injured employee seeks medical treatment across provinces and other places, he or she can go through the national unified service portal (hereinafter referred to as the national unified service portal) such as the national social insurance public service platform, the human resources and social security government service platform, the handheld 12333 APP, and the electronic social security card (hereinafter referred to as the national unified service portal) or the window of the handling agency in the place where he or she participates in the insurance. The handling agency of the insured place shall upload the filing information received offline to the work-related injury insurance remote medical treatment system in a timely manner, form a national database of filing personnel for remote medical treatment, and carry out dynamic management for timely access by the handling agency and the agreement institution at the place of medical treatment.

(2) Standardize the process of seeking medical treatment. When an injured employee goes through the admission formalities, the agreement institution shall check the identity information and filing information of the injured employee, provide medical, rehabilitation and assistive device allocation services in strict accordance with the relevant provisions of the work-related injury insurance policy, treat the injury, separate the injury and illness, and provide reasonable diagnosis and treatment. The work-related injury insurance fund shall not pay the expenses incurred by the injured employee in the treatment of non-work-related injuries, the expenses incurred in the course of medical treatment that exceed the standard and exceed the scope of the catalogue and do not conform to the routine diagnosis and treatment, and other expenses that violate the relevant provisions of work-related injury insurance.

(3) Standardize the settlement process. The settlement of medical treatment in other places for injured employees shall be settled directly with social security cards, and the work-related injury insurance fund shall be paid according to the project. The work-related injury insurance remote medical treatment system provides two modes: interface and login, and supports provinces to complete cost settlement. The agreement institution shall promptly transmit the medical treatment, settlement and other relevant information of the injured employee to ensure that the information is true, complete and accurate, and shall not be tampered with.

7. Strengthen the management of funds for medical treatment in other places

(1) Clarify the method of fund management. The part paid by the work-related injury insurance fund for cross-provincial and non-local medical expenses shall be prepaid first and then cleared among provinces. After the initial amount of advance payment is confirmed, it will be adjusted annually, and the medical expenses will be fully settled in each province on a quarterly basis. The initial amount of the advance payment is half a year's worth of funds, which shall be reported by each province according to the amount paid by the cross-provincial and non-local medical injury insurance fund in previous years and the estimated release effect after the implementation of the policy, and the ministerial-level agency shall review and determine. The initial amount of the advance payment shall be disbursed within three months from the date of issuance of this notice at the latest.

The advance payment comes from the work-related injury insurance fund of each co-ordinated region. The province where the medical treatment is located (hereinafter referred to as the province of medical treatment) can use the advance payment of each insured province to pay for the direct settlement of the relevant expenses of the injured employees who seek medical treatment in other places in the insured place.

(2) Establish a comprehensive cross-provincial coordination mechanism. The prepayment and liquidation funds for cross-provincial and non-local medical treatment shall be allocated by the insured province and the province of medical treatment. All provincial-level agencies and financial departments shall, in accordance with the requirements of the Regulations for the Direct Settlement of Work-related Injury Insurance for Cross-Provincial and Non-local Medical Treatment (see Annex, hereinafter referred to as the Regulations), coordinate the allocation and collection of funds. Ministerial-level agencies are responsible for coordinating and supervising the timely disbursement of funds by the provinces in accordance with regulations.

During the pilot period, the Ministry of Human Resources and Social Security and the Ministry of Finance will report on the timely allocation of advance funds and liquidation funds in each province. For the insured provinces that are in arrears of advance payments and liquidation funds, the Ministry of Medical Treatment may, depending on the circumstances, propose to the ministry-level agency to terminate the direct settlement business of the insured province.

(3) Clarify relevant management matters. Bank charges and bank bills incurred in the process of allocating funds for cross-provincial and non-local medical treatment shall not be included in the work-related injury insurance fund. The interest accrued on the advance payment in the Ministry of Medical Treatment shall be owned by the Ministry of Medical Treatment. The provisional payments and temporary receipts formed in the process of settlement and settlement of cross-provincial and non-local medical treatment expenses shall be accounted for in accordance with the provisions of the relevant accounting system.

(4) Strengthen risk prevention and control. The medical treatment, rehabilitation, and allocation of assistive devices and the corresponding expenses of the insured persons seeking medical treatment in other places in the work-related injury agreement institutions of each province shall be included in the audit, supervision and audit of the work-related injury insurance fund at the place of medical treatment. The insured place should strengthen communication and coordination with the place of medical treatment, establish a management mechanism for remote medical treatment of work-related injuries, and focus on large-amount, high-frequency, two-way expenditures between the place of filing and the place of insurance during the filing period, etc., implement the audit of expense data, and scientifically and effectively carry out the management of relevant remote medical treatment. The place of medical treatment should provide convenient conditions as much as possible, and actively cooperate with the insured place to carry out post-audit and supervision work. According to the progress of the work of medical treatment in other places, the Ministry of Human Resources and Social Security will organize and carry out joint review and mutual inspection in a timely manner, focusing on large expenses or difficult cases of medical treatment in other places, and increase the supervision of fund expenditures.

8. Accelerate the construction of a remote medical treatment information system for work-related injury insurance

(1) Establish a national information system. The Ministry of Human Resources and Social Security relies on the special network of financial insurance projects to organize the construction of a remote medical treatment system for work-related injury insurance. Realize the coordination of work-related injury insurance agencies and agreement institutions at all levels to handle cross-provincial and non-local medical treatment business of work-related injury insurance, ensure that information such as filing and settlement is transmitted across institutions and levels, and support regular settlement and clearing of work-related injury insurance funds for medical treatment in other places.

(2) Accelerate network access to information systems. Each province should combine the informatization of work-related injury insurance in the province, choose the interface or login mode to access the work-related injury insurance remote medical treatment system, and at the same time should accelerate the promotion of the province's work-related injury medical treatment, work-related injury rehabilitation and assistive device configuration costs online direct settlement. Provinces that have realized the provincial centralization of information systems are required to choose the interface mode for access in principle, and the provinces that adopt the settlement channel method of non-human resources and social security departments shall organize the transformation of relevant systems according to the overall requirements of cross-provincial and non-local medical treatment settlement of work-related injury insurance, so as to realize the collaborative sharing of cross-provincial and non-local medical treatment settlement information of work-related injury insurance. Provinces that have not yet realized the provincial centralization of information systems should organize agreement institutions and handling agencies that are included in cross-provincial and remote medical treatment, and conduct business handling by logging in to the work-related injury insurance remote medical treatment system, and complete the transition to the interface mode by the end of 2024.

(3) Promote the application of social security cards. All provinces should use the social security card as the identification and direct settlement voucher for the medical treatment of employees injured at work in other places, give priority to the issuance of cards to those who need medical treatment in other places, and guide them to issue electronic social security cards, and establish a cross-provincial card service mechanism. In accordance with the national inter-provincial card use technology plan and unified interface specifications, complete the card reading, code scanning terminal and card use environment transformation, and support cross-provincial card authentication.

(4) Improve access to public services. The Ministry of Human Resources and Social Security will rely on the national unified service portal to provide convenient and fast services for employees injured at work, such as filing applications for medical treatment in other places and inquiring about medical settlement details. All provinces should also use local online and offline service channels to improve the level of handling and management services, and provide convenient, high-quality and efficient services for employees injured at work.

9. Job requirements

(1) Strengthen organizational leadership. During the pilot period, human resources and social security departments at all levels should take the direct settlement of cross-provincial and non-local medical treatment as an important task to implement the State Council's "cross-provincial general office" and the innovation and promotion of human resources and social security informatization and convenience services, strengthen leadership, overall planning, careful organization, coordination and promotion, overcome difficulties, and include them in the assessment and management of target tasks to ensure that the tasks are completed on time. According to the request of the handling agency, the financial department shall allocate funds for medical treatment across provinces and other places in a timely manner according to the regulations, reasonably arrange the work funds, strengthen the reconciliation management with the handling agency, and ensure that the accounts are consistent and the accounts are consistent. The health department should guide relevant medical institutions to actively cooperate with the implementation of various tasks of cross-provincial and remote medical treatment, improve service capacity, and ensure the quality and safety of medical care. All localities and departments should conscientiously summarize the work experience and effectiveness during the pilot period, promptly study and solve the problems that arise, ensure the steady progress of the pilot work, and lay a solid foundation for expanding the scope of direct settlement personnel and expense settlement in a timely manner.

(2) Strengthen team building. It is necessary to strengthen the construction of the national and provincial medical treatment work teams in other places, especially in areas where the number of people seeking medical treatment in other places is concentrated, according to the needs of management services, strengthen the guarantee of institutions, personnel and office conditions, rationally allocate professional staff, and fully mobilize the enthusiasm of the agreement institutions to ensure service quality and improve work efficiency.

(3) Do a good job of publicity and guidance. Make full use of the existing 12333 consultation service telephone and the portal website of human resources and social security departments at all levels, expand a variety of information service channels, guide reasonable and orderly medical treatment, and provide information on the agreement institutions in the place of medical treatment, information on reimbursement policies in the place of insurance, cross-provincial work-related injury insurance business handling guides, inquiry and complaint and other services.

The provincial human resources and social security departments (bureaus) should take the lead in seriously summarizing the pilot work, and report to the Ministry of human resources and social security before the end of the pilot. The Ministry of Human Resources and Social Security will take the lead in carrying out pilot assessments in a timely manner, strengthen operational analysis, improve work measures, and propose next work arrangements. If you encounter major problems in the process of advancing the work, please report to the Ministry of Human Resources and Social Security in a timely manner.

Attachment: Regulations for the direct settlement of work-related injury insurance for cross-provincial and non-local medical treatment

Ministry of Human Resources and Social Security

treasury

National Health Commission

January 12, 2024

(This piece is voluntarily disclosed)

(Contact unit: Department of Work-related Injury Insurance, Ministry of Human Resources and Social Security)

annex

Regulations for the direct settlement of work-related injury insurance for cross-provincial and non-local medical treatment

Chapter I: General Provisions

Article 1 These regulations are formulated in order to implement the relevant requirements of the "Guiding Opinions of the State Council on Accelerating the Promotion of "Cross-Provincial General Handling" of Government Services (Guo Ban Fa [2020] No. 35) and other documents, to promote the direct settlement of cross-provincial and non-local medical expenses of work-related injury insurance, to standardize the management of medical treatment in other places, and to improve service levels.

Article 2 These regulations apply to the direct settlement and management services of cross-provincial and non-local medical expenses of work-related injury insurance.

Article 3 Eligible work-related injury workers who are insured outside the province may be directly settled in accordance with the provisions of these Regulations, such as non-third-party liability for inpatient work-related injury medical treatment, inpatient work-related injury rehabilitation and assistive device allocation (including replacement, the same below).

Article 4 Employees with the following work-related injuries who have participated in work-related injury insurance and have completed the work-related injury identification, work-related injury recurrence confirmation, work-related injury rehabilitation confirmation or assistive device configuration confirmation may apply for direct settlement of medical expenses across provinces and other places:

(1) Employees with work-related injuries who live (work) in other places for a long time: refer to employees who live outside the insured province for a long time or are dispatched by the employer to work outside the insured province for a long time;

(2) Employees injured at work who are referred to and transferred to hospitals in other places: refer to employees injured at work who need to be referred to hospitals outside the insured province for medical treatment due to medical conditions.

Article 5 Social insurance agencies at all levels and work-related injury insurance agreement institutions shall carry out direct settlement of work-related injury insurance for cross-provincial and non-local medical treatment through the National Work-related Injury Insurance Non-local Medical Treatment Settlement Information System (hereinafter referred to as the Work-related Injury Insurance Non-local Medical Treatment System), so as to realize the electronic transmission of settlement information. The work-related injury insurance remote medical treatment system provides two access modes: interface and login.

Article 6 The work of direct settlement of cross-provincial and non-local medical treatment shall be subject to unified management and hierarchical responsibility. The Ministry of Human Resources and Social Security is responsible for uniformly organizing and guiding the inter-provincial management services for medical treatment in different places, and is responsible for supervising and urging the provincial social insurance agencies to coordinate with the financial departments to allocate funds in a timely manner in accordance with regulations; the provincial human resources and social security departments (hereinafter referred to as the human resources and social security departments) are responsible for improving the provincial settlement and management functions for medical treatment in other places, and uniformly organizing, coordinating, and implementing the management services for medical treatment in other places across provinces; and the human resources and social security departments below the provincial level shall do a good job in the work related to medical treatment in other places across provinces in accordance with the requirements of the state and the province.

Article 7 The part paid by the work-related injury insurance fund for cross-provincial and non-local medical expenses shall be prepaid first and then liquidated among the provinces, and the prepaid funds shall come from the work-related injury insurance fund of the overall area to which the injured employee belongs.

Article 8: All localities should optimize handling procedures, simplify handling procedures, unblock information channels, improve service quality, and ensure that business handling is lawful, convenient, timely, open, and safe.

Chapter II Filing Management

Article 9 The direct settlement of work-related injury insurance for cross-provincial and non-local medical treatment shall be subject to a record-filing management system. The handling agency of the place where the insurance is insured shall provide convenient online and offline filing channels for the injured employee, handle the filing application submitted by the injured employee in a timely manner, and inform the result in accordance with the law.

Article 10 The handling agency of the place of insurance shall go through the filing formalities for the injured employees in accordance with the regulations, and collect the following materials respectively:

(1) Employees with work-related injuries who live (work) in other places for a long time: "Record Form for Direct Settlement of Work-related Injury Insurance for Cross-provincial and Non-local Medical Treatment (Rehabilitation)" (see Annex 1), supporting materials for long-term residence in other places or supporting materials for permanent work in other places;

(2) Employees injured at work who are referred to and transferred to hospitals in other places: "Record Form for Direct Settlement of Work-related Injury Insurance for Cross-provincial and Non-local Medical Treatment (Rehabilitation)", and opinions on referral and transfer of hospital by the agreement institutions stipulated by the participating provinces;

(3) Employees injured at work with assistive devices in different places: "Record Form for Direct Settlement of Work-related Injury Insurance for Cross-provincial and Non-local Allocation of Assistive Devices" (see Annex 2), and provide the opinions of the agreement agency on referral and transfer, and supporting materials for long-term residence or permanent work in other places according to the three circumstances.

Article 11 The validity period for the filing of long-term resident (work) work-related injury workers in other places and cross-provincial referral and transfer of work-related injury employees shall be uniformly stipulated by the participating provinces. The insured province shall guide the long-term residence (work) work-related injury employees in other places to seek medical treatment in an orderly manner, and may reasonably set the time limit requirements for changing or canceling the record, which shall not exceed 6 months in principle.

Article 12 In principle, the handling agency of the place where the insured employee is insured shall file directly with the city or municipality directly under the Central Government where the employee is seeking medical treatment when filing for the work-related injury. After the work-related injury employee completes the filing, he or she can enjoy the direct settlement service of inpatient work-related injury medical expenses, inpatient work-related injury rehabilitation expenses or assistive device configuration expenses in all inter-provincial and non-local medical treatment direct settlement agreement institutions opened in the place of medical treatment.

Article 13 After an injured employee has filed for medical treatment in a different place, he or she may receive medical treatment at the place of medical treatment for multiple times and enjoy direct settlement services for medical treatment in other provinces and places during the validity period of the record. Those who have gone through the admission procedures within the validity period of the filing are not subject to the validity period of the filing, and the relevant expenses can be directly settled normally.

If a long-term resident (worker) person who crosses provinces and places and does need to return to the insured place for medical treatment within the validity period of the record, he or she can enjoy the work-related injury insurance cost settlement service in the insured place and implement the policy of the insured place.

Article 14 The handling agency of the place of insurance shall handle the filing application submitted by the injured employee in a timely manner in accordance with the regulations, and for those who meet the filing conditions, in principle, it shall complete the application within 5 working days and inform the applicant. If the filing materials are incomplete, the materials to be supplemented and corrected shall be notified at one time, and if the filing conditions are not met, the applicant shall be informed of the filing conclusion.

The handling agency that receives the filing application information shall, after the completion of the application, promptly send back the results to the work-related injury insurance remote medical treatment system.

Article 15 If an injured employee who has completed the filing of long-term residence (work) in another place changes his or her place of residence (work) or other information, or terminates his or her long-term residence (work) in another place, he or she shall promptly change the filing information or cancel the filing.

The handling agency that receives the application for filing change shall upload the results to the work-related injury insurance remote medical treatment system in a timely manner after the completion of the application.

Article 16 The medical expenses incurred by the injured employee who fails to complete the filing and registration in accordance with the provisions or who seek medical treatment in a place other than the inter-provincial or non-local direct settlement agreement shall not be directly settled.

Chapter III: Management of Medical Treatment

Article 17 During the pilot period, each province shall, in accordance with the principle of reasonable layout and step-by-step inclusion, select within 40% of the prefectures and cities in the province to carry out the pilot project of direct settlement of cross-provincial and non-local medical treatment for work-related injury medical treatment. The handling agency of the pilot city shall determine the medical institutions of the city's direct settlement agreement for cross-provincial and non-local medical treatment according to the actual situation. Each province should identify at least one agreed rehabilitation institution and one assistive device allocation institution, and each region can gradually increase the number according to the progress of the work.

Article 18 The work-related injury insurance remote medical treatment system shall establish a national cross-provincial remote medical treatment direct settlement agreement institution database, and the provincial handling agency shall promptly report the list of cross-provincial remote medical treatment direct settlement agreement institutions to the work-related injury insurance remote medical treatment system. The work-related injury insurance remote medical treatment system relies on the national social insurance public service platform and other national unified service portals to provide real-time inquiry services.

In the event of a new addition, suspension or termination of the agreement, suspension or closure of business, the provincial-level agency shall promptly report to the work-related injury insurance remote medical treatment system and update the database of the agreement institution.

Article 19 When an injured employee seeks medical treatment at an institution that has a direct settlement agreement for medical treatment in an inter-provincial or non-local place where he or she seeks medical treatment, he or she shall take the initiative to identify himself, present his or her social security card and other valid identity certificates, and comply with the procedures and service specifications for medical treatment at the place of medical treatment.

The agreement institution at the place of medical treatment shall provide the same medical, rehabilitation, and assistive device allocation services as the local work-related injury workers for the work-related injuries in other places. The agency handling the place of medical treatment is responsible for specifically reviewing the expenses incurred in the area for medical treatment and inpatient work-related injuries, inpatient work-related injury rehabilitation, and the allocation of assistive devices.

Chapter IV Management of Advance Payments

Article 20 The advance payment is the fund prepaid by the insured province to the province for medical treatment to pay for the medical expenses of the injured workers in the insured province for medical treatment in other places, and the funds are earmarked for special use, and no organization or individual may embezzle or misappropriate them. In principle, the annual prepayment amount shall be adjusted annually according to twice the quarterly average of the settlement funds for cross-provincial and non-local medical treatment of work-related injury insurance in the previous year. The province of medical treatment can adjust the use of the advance payment of each participating province. 

Article 21 The initial amount of the advance payment is half a year's worth of funds, which shall be reported by each province according to the amount paid by the inter-provincial and non-local medical injury insurance fund in previous years and the estimated release effect after the implementation of the policy, and the ministerial-level agency shall approve and generate the "____ Province (Autonomous Region, Municipality) Work-related Injury Insurance Inter-provincial and Non-local Medical Treatment Prepayment Notice" (see Annex 3) and "____ Provincial (Autonomous Region, Municipal) Work-related Injury Insurance Inter-provincial and Non-local Medical Treatment Prepayment Payment Notice" (See Annex 4), the provincial agencies in the work-related injury insurance remote medical treatment system after downloading the payment and collection of the financial departments at the same level in accordance with the regulations.

Article 22 Before the end of January of each year, the ministerial-level agency shall approve the prepayment payable and receivable of the provincial-level agency for the current year according to twice the quarterly average of the settlement funds of the previous year, and generate the "National Work-related Injury Insurance Cross-Provincial and Non-local Medical Treatment Prepayment Adjustment Schedule" (see Annex 5), and issue the "____ Province (Autonomous Region, Municipality) Work-related Injury Insurance Cross-Provincial and Non-local Medical Treatment Prepayment Adjustment Payment Notice" (see Annex 6) and "____ Province (Autonomous Region, Municipality) Work-related Injury Insurance Cross-provincial and Non-local Medical Treatment Prepayment Adjustment Payment Notice" (See Appendix 7) and issued through the work-related injury insurance remote medical treatment system. 

Article 23 During the annual adjustment, if the amount of prepayment receivable from the province of medical treatment is lower than the amount of the previous year, the corresponding funds of the insured province shall be returned, and the returned funds shall be included in the notice of adjustment of the amount of prepayment for inter-provincial and non-local medical treatment in the province of medical treatment in the current year, and "*" shall be added before the name of the corresponding insured province.

The funds receivable from the insured province and returned by the province for medical treatment shall be included in the notice of adjustment of the prepaid amount for inter-provincial and non-local medical treatment of the insured province in the current year, and "*" shall be added before the name of the corresponding province for medical treatment. 

Article 24 The provincial-level agency shall submit the notice of adjustment of the prepaid amount to the financial department within 5 working days after receiving the notice of adjustment of the prepaid amount through the work-related injury insurance remote medical treatment system. The provincial finance department of the insured place shall transfer the payment notice and the application plan submitted by the provincial agency within 10 working days after reviewing the payment notice and the application plan submitted by the provincial agency in accordance with the regulations. When the provincial finance department allocates the advance payment according to the regulations, it shall indicate the type of business (advance payment or liquidation funds), and the allocation information will be fed back to the provincial agency within 5 working days after the transfer is completed. 

Article 25 When the provincial-level agency completes the payment confirmation, it shall feedback the payment bank type, transaction serial number and transaction date and other information in the work-related injury insurance remote medical treatment system to ensure that the information is true and accurate, and in principle, the provinces shall complete the collection and payment of the annual advance payment adjustment amount before the end of February each year.

Article 26 Establish a mechanism for early warning and increase of advance payments. The utilization rate of the advance payment is an early warning indicator, which refers to the proportion of the quarterly settlement funds for remote medical treatment to the advance payment. When the prepayment utilization rate of an insured province reaches 70%, it is a yellow alert, and when the prepayment utilization rate reaches 80% or more, it is a red alert, and the medical province can initiate an emergency prepayment increase process for the insured province. 

Article 27 When there is a red alert on the utilization rate of the advance payment, the provincial-level agency at the place of medical treatment may, within 3 working days from the date of signing and signing the current liquidation, log in to the work-related injury insurance system for remote medical treatment and submit an application for an increase in the prepayment amount to the ministry-level agency. After receiving the application, the ministerial-level handling agency shall review and confirm the amount proposed by the provincial-level handling agency in the place of medical treatment in combination with the amount of liquidation funds in the current and previous periods of the province and the insured province, and issue the Notice of Emergency Increase in the Prepayment Amount of Work-related Injury Insurance in ____ Province (Autonomous Region, Municipality) and the Notice of Emergency Adjustment and Increase of the Prepayment Amount for Inter-provincial and Non-local Medical Treatment of Work-related Injury Insurance in ____ Province (Autonomous Region, Municipality) (see Annex 9) to the provincial-level handling agency in the place of insurance and medical treatment respectively. 

In principle, the Ministry of Medical Care shall submit an emergency increase application at most once per quarter, and the maximum amount of each application shall be twice the monthly settlement amount of the current quarter.

Article 28 After receiving the notice of emergency increase in the prepayment amount issued by the ministry-level agency, the provincial agency shall submit it to the financial department at the same level within 5 working days. The provincial finance department shall complete the allocation of the emergency increase fund of the advance payment within 10 working days after reviewing the payment notice and the application plan submitted by the provincial agency in accordance with the regulations. In principle, the emergency increase in the amount of advance payment should be completed before the next liquidation. 

29th provincial financial departments in accordance with the provisions of the completion of the amount of advance payment and increase in the amount of payment and collection, within 5 working days will be allocated and collection information feedback to the provincial agency, the provincial agency at the same time to the ministry agency feedback to the account information.

Article 30 The handling agency shall set up a detailed account of "prepayment for medical treatment in other places" under the "temporary payment" account, and carry out detailed accounting according to the prepaid area under the detailed account, and calculate the prepaid funds for medical treatment in other provinces and other places allocated by the insured area to the medical treatment area. It reflects the prepayment for inter-provincial and non-local medical treatment at the same level that is not explained by the provincial-level handling agency to the higher-level handling agency, the prepayment for inter-provincial and non-local medical treatment at the provincial level allocated by the provincial-level handling agency in the insured area to the provincial-level handling agency in the medical treatment area, and the prepayment for inter-provincial and non-local medical treatment received by the handling agency at all levels in the insured area that belongs to the fund at the same level.

The handling agency shall set up detailed accounts of "prepayment for medical treatment in other places", "liquidation funds for medical treatment in other places" and "funds for medical treatment in other places" under the "temporary collection" account, among which, the detailed accounts of "advance payment for medical treatment in other places" and "settlement funds for medical treatment in other places" are used to calculate the advance payment and liquidation funds for medical treatment collected by the higher-level handling agencies in the insured area received by the lower-level handling agencies, and the detailed account of "medical treatment funds in other places" is used to calculate the prepayment and liquidation funds for medical treatment in other places allocated by the insured areas in the medical treatment area.

Article 31 Ministerial-level agencies are responsible for coordinating and supervising the timely allocation of funds by the provinces in accordance with regulations.

Chapter 5 Settlement of Medical Treatment Expenses

Article 32 The settlement of medical treatment expenses refers to the act of paying fees to the agreement institution in accordance with the agreement or relevant provisions after the handling agency of the place of medical treatment and the local agreement institution have reviewed and reconciled the medical expenses in other places. The reconciliation of medical expenses refers to the act of confirming the amount paid by the work-related injury insurance fund between the handling agency and the agreement institution at the place of medical treatment for inpatient work-related injuries, inpatient work-related injury rehabilitation and the allocation of assistive devices. 

Article 33 The relevant provisions of the Catalogue of Work-related Injury Insurance Diagnosis and Treatment Items, the Catalogue of Work-related Injury Insurance Drugs, the Standards for Work-related Injury Insurance Hospitalization Services, and the Work-related Injury Rehabilitation Service Items (hereinafter referred to as the Catalogue of the Place of Treatment) shall be implemented for the direct settlement of in-patient work-related injury medical expenses and inpatient work-related injury rehabilitation expenses directly settled by employees seeking medical treatment in other places. The allocation of assistive devices shall be subject to the relevant provisions of the catalogue of assistive devices in the insured place.

Article 34 Where an injured worker goes to another place for medical treatment (rehabilitation), the province that adopts the interface model shall check the identity information and filing information of the injured employee when handling the admission registration. When the employee is discharged from the hospital, check the identity information and filing information again, and after completing the online settlement through the provincial information system, the basic information of the employee, the information of the medical institution, the clinical diagnosis, the treatment details and the settlement and other information will be uploaded to the work-related injury insurance remote medical treatment system through the provincial system within 5 working days.

In provinces that adopt the login mode, when handling the admission registration, the handling personnel of the agreement institution shall check the identity information and filing information of the injured employee. During the hospitalization, the handling staff of the agreement institution will upload the details of the split expenses to the remote medical treatment system of the work-related injury insurance on a daily basis. At the time of discharge, the identity information and filing information shall be checked again, which is a fee paid by the work-related injury insurance fund, and shall be settled by the handling agency of the place of medical treatment and the agreement institution according to the agreement, and the injured employee shall pay the expenses that should be paid by himself in accordance with the "Settlement Form for Cross-provincial and Non-local Medical Treatment of Work-related Injury Insurance in ______ Province (Autonomous Region, Municipality)" issued by the agreement institution (see Annex 10). The agreement institution shall upload all settlement information to the remote medical treatment system of work-related injury insurance within 5 working days after settlement.

For injured employees who are hospitalized and rehabilitated, in principle, the agreement institution should also upload the rehabilitation plan to the work-related injury insurance remote medical treatment system before the discharge settlement.

Article 35 Where an injured employee goes to a different place to allocate assistive devices, in the province that adopts the interface model, the handling personnel of the agreement institution shall provide the allocation service after checking the identity information, filing information and the allocation fee verification notice of the injured worker. After completing the online settlement through the provincial information system, the settlement information such as the configuration cost details will be uploaded to the work-related injury insurance remote medical treatment system through the provincial system within 5 working days.

In provinces that adopt the login mode, the handling personnel of the agreement institution shall provide configuration services after checking the identity information, filing information and allocation fee verification notice of the injured employee. After the configuration is completed, the expenses paid by the work-related injury insurance fund shall be settled by the handling agency of the place of medical treatment and the agreement institution according to the agreement, and the injured employee shall pay the expenses exceeding the catalogue or exceeding the limit in accordance with the "Settlement Form for Cross-provincial and Non-local Medical Treatment of Work-related Injury Insurance in ______ Province (Autonomous Region, Municipality)" issued by the agreement institution. The agreement institution shall upload all settlement information to the remote medical treatment system of work-related injury insurance within 5 working days after settlement.

Article 36 The handling agency of the place of medical treatment shall promptly review and reconcile and confirm the settlement expenses incurred by each agreement institution in the previous month, and make monthly settlement with the agreement institution.

In provinces that adopt the interface mode, after completing the expense review and reconciliation confirmation through the provincial system, the handling agency of the place of medical treatment shall upload the monthly settlement information to the work-related injury insurance remote medical treatment system in a timely manner before the 20th of each month.

On the 20th of each month, the work-related injury insurance remote medical treatment system summarizes the review and reconciliation confirmation of the cross-provincial and remote medical treatment expenses of the previous month, and generates a monthly settlement amount, and the handling agency at the place of medical treatment shall timely allocate the amount payable by the work-related injury insurance fund to the agreement institution in accordance with the agreement.

Article 37 Where the process of hospitalization (allocation) for work-related injuries at the place of medical treatment spans a natural year, the settlement time shall be based on the date of discharge and settlement, and the settlement shall be made as a whole.

Article 38 The expenses incurred in the treatment of non-work-related injuries, the expenses incurred in the treatment of inpatient work-related injuries and the rehabilitation of inpatient work-related injuries and the allocation of assistive devices incurred in cross-provincial and non-local medical treatment shall be reviewed by the handling agency at the place of medical treatment in accordance with the regulations, and the expenses incurred in the treatment of non-work-related injuries, the expenses incurred in the medical treatment that exceed the standard and exceed the scope of the catalogue and do not conform to the routine diagnosis and treatment, and other expenses in violation of the relevant provisions of work-related injury insurance, shall be deducted in accordance with the provisions of the agreement and uploaded to the work-related injury insurance remote medical treatment system.

Article 39 If an injured employee is unable to settle directly due to a failure in the settlement network system, medical treatment vouchers, etc., after filing for medical treatment in a different place, the relevant expenses shall be reimbursed manually in accordance with the provisions of the place of insurance. Before manual reimbursement in the place of insurance, the employee should earnestly perform the review duty to verify whether the injured employee has been directly settled at the place where he or she received medical treatment, so as to eliminate duplicate reimbursement.

Chapter VI Settlement of Expenses

Article 40 The settlement of cross-provincial and non-local medical treatment expenses refers to the process of confirming the amount receivable or payable for cross-provincial and non-local medical treatment expenses between provinces and allocating them according to the facts.

Article 41 The work-related injury insurance system for remote medical treatment shall automatically generate the "National Work-related Injury Insurance Cross-Provincial and Non-local Medical Treatment Expenses Settlement Table" (see Annex 11) on the 21st day of the second month of each quarter, the "Settlement Table of Expenses Payable for Cross-provincial and Non-local Medical Treatment of Work-related Injury Insurance of ____ Provinces (Autonomous Regions, Municipalities)" (see Annex 12), the "Detailed Table of Payment for Cross-provincial and Non-local Medical Treatment of Work-related Injury Insurance in _____ Provinces (Autonomous Regions, Municipalities)" (see Annex 12-1), and the "Settlement Table of Cross-provincial and Non-local Medical Treatment of Work-related Injury Insurance in _____ Provinces (Autonomous Regions, Municipalities)" (see Annex 12-1), municipal) work-related injury insurance cross-provincial and non-local medical treatment fund review deduction details (see Annex 12-2), "____ provinces (autonomous regions, municipalities) work-related injury insurance cross-provincial and non-local medical treatment payable liquidation table" (see Annex 13), each provincial agency can query the above-mentioned liquidation information in each region of the province through the work-related injury insurance remote medical treatment system, and confirm the above content before the 25th of the second month of each quarter. 

Article 42 Before the end of the second month of each quarter, the ministerial-level agency shall generate the Notice of Payment of Inter-provincial and Non-local Medical Treatment Expenses of Work-related Injury Insurance of ____ Province (Autonomous Region, Municipality) and the Notice of Collection of Inter-provincial and Non-local Medical Treatment Expenses of Work-related Injury Insurance of ____ Province (Autonomous Region, Municipality) (see Annex 15) according to the confirmed Settlement Form of Cross-provincial and Non-local Medical Treatment Expenses of Work-related Injury Insurance, and publish them in the work-related injury insurance remote medical treatment system. 

Article 43 After receiving the "Notice of Payment of Inter-provincial and Non-local Medical Treatment Expenses of Work-related Injury Insurance of ____ Province (Autonomous Region, Municipality)" and "Notice of Collection of Inter-provincial and Non-local Medical Treatment Expenses of Work-related Injury Insurance of ____ Province (Autonomous Region, Municipality)" through the work-related injury insurance remote medical treatment system, the provincial-level financial department shall submit it to the financial department at the same level within 5 working days, and the financial department shall allocate funds to the provincial-level financial department of the place of medical treatment within 10 working days after reviewing the payment notice and application plan submitted by the handling agency in accordance with the regulations. After the provincial finance department completes the allocation and collection of liquidation funds, it will feedback the transfer and collection information to the provincial agency within 5 working days, and the provincial agency will feedback the account information to the ministerial agency. In principle, the current liquidation funds should be disbursed before the next liquidation.

Article 44 In principle, the direct settlement of cross-provincial and non-local medical treatment expenses in the current quarter shall be collected and paid before the end of the second month of the following quarter, and the postponement of collection and payment shall not exceed one quarter. The direct settlement of medical expenses across provinces and places in the current year shall be completed in the first quarter of the following year at the latest. 

Chapter VII: Information Management

Article 45 The Ministry of Human Resources and Social Security shall organize and construct the work-related injury insurance system for medical treatment in other places. Provinces that have achieved provincial-level centralization of information systems are required to choose the interface mode to access the work-related injury insurance remote medical treatment system in principle, and provinces that have not yet realized the provincial-level centralization of information systems should conduct business handling by logging in to the work-related injury insurance remote medical treatment system, accelerate the integration of the provincial system of work-related injury insurance, establish a networked settlement channel with the agreement institutions, and transition to the interface mode as soon as possible.

Article 46 The social security card is the identity certificate for the direct settlement of medical treatment for employees injured at work across provinces and other places. The agreement institution shall support employees who seek medical treatment in different provinces and other places and are directly settled with their social security cards for inpatient work-related injuries, inpatient work-related injury rehabilitation expenses, and assistive device allocation expenses.

Article 47: The Ministry of Human Resources and Social Security will rely on the national social insurance public service platform, the human resources and social security government affairs service platform, the handheld 12333 APP, electronic social security cards and other national unified service portals to provide insured persons with public services such as filing applications for cross-provincial and non-local medical treatment for insured employees with work-related injuries, inquiries by agreement institutions, and inquiries about the details of work-related injury insurance cross-provincial and non-local medical treatment. Handling agencies at all levels and work-related injury insurance agreement institutions shall upload relevant information to the work-related injury insurance remote medical treatment system in a timely manner to ensure that the information of the work-related injury insurance remote medical treatment system is timely and accurate.

Chapter VIII Audit and Supervision

Article 48: Cross-provincial and non-local medical services shall be subject to the management of the place of medical treatment. The handling agency at the place of medical treatment should include the work of seeking medical treatment in other places into the scope of the agreement, and clarify the relevant content in the agreement, so as to effectively protect the rights and interests of employees injured at work. It is necessary to guide and urge the agreement bodies to provide services as required, and promptly transmit medical treatment, settlement, and other relevant information for employees injured at work, to ensure that the information is true and accurate, and must not be tampered with.

Article 49: The handling agency at the place of medical treatment shall establish channels for complaints and reports from employees who seek medical treatment in other places for work-related injuries, promptly accept complaints and reports, and inform the complainant or informant of the results. Major violations of laws and regulations that have been verified shall be implemented and reported in accordance with relevant regulations.

Article 50 If the handling agency at the place of medical treatment finds that an injured employee who has been injured at work in another place has committed serious violations, it shall suspend his direct settlement and report to the ministry-level handling agency step by step, and the ministerial-level handling agency shall coordinate with the handling agency in the place where the insurance is insured to deal with it in accordance with relevant regulations.

The agency at the place of medical treatment shall assist the agency in the place of insurance to verify the medical bills, ensure the authenticity of the expenses, and prevent and crack down on fraudulent acts such as forgery of bills to obtain work-related injury insurance funds.

Article 51: Ministerial-level handling agencies shall organize provincial-level handling agencies to carry out joint examination and mutual inspection of medical treatment across provinces and in different places through means such as inspections and inspections, cross-examinations, and third-party reviews, focusing on large-amount, high-frequency, and two-way expenditures during the filing period and the place of insurance. The ministry-level agency is responsible for coordinating and handling disputes and disputes arising from the review of expenses, the allocation of funds and the handling of violations.

Article 52 Handling agencies at all levels shall strengthen the monitoring of the operation of direct settlement of cross-provincial and non-local medical treatment and the review of expenses, improve the risk assessment and early warning mechanism for the operation of work-related injury insurance funds, and regularly carry out analysis of the operation of direct settlement of cross-provincial and non-local medical treatment.

Chapter IX: Supplementary Provisions

Article 53 The business files of medical treatment in other places shall be kept separately by the handling agency in the place of insurance participation and the handling agency in the place of medical treatment in accordance with the business they handle.

Article 54 Each provincial-level work-related injury insurance agency may, in accordance with these Regulations, formulate procedures for the direct settlement of medical treatment in other places in its own region.

Article 55: Handling agencies at all levels shall, in accordance with the principle of serving the convenience of the people, do a good job of policy publicity and medical treatment guidelines, and rely on public service websites, handling service halls, and other websites to publish service guidelines for use by injured workers when seeking medical treatment across provinces and places.

Article 56 Where the relevant provisions of the "Regulations for Handling Work-related Injury Insurance" on medical treatment in other places are inconsistent with these Regulations, these Regulations shall be followed.