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Ⅰ. 의료급여의 개요······································3
1. 의료급여의 개념 및 목적··························································3
2. 지원대상······················································································5
3. 지원유형······················································································6
4. 급여기준······················································································6
5. 전산시스템 활용·········································································8
6. 의료급여 업무흐름도·······························································10
Ⅱ. 보장기관 등·········································12
1. 보장기관(법 제5조) ··································································12
2. 의료급여심의위원회
(법 제6조) ·················································································12
3. 업무위탁기관(법 제33조 제2항) ·············································16
Ⅰ. 의료급여 수급자 선정기준·····························19
1. 의료급여 단위···········································································19
2. 수급자 유형별 선정기준··························································20
Ⅱ. 의료급여 수급자 자격관리·····························55
1. 수급자 유형별 선정 절차························································55
2. 수급자 종별 선정 요령··························································· 56
3. 급여개시 및 종료·····································································57
4. 의료급여증(법 제8조) ······························································58
5. 의료급여수급자 자격 취득 및 상실·······································60
6. 사회복지시설 신설 업무처리절차·········································· 71
Ⅰ. 의료급여 지원범위 및 절차····························75
1. 의료급여 지원범위···································································75
2. 의료급여 본인부담···································································80
3. 요양비························································································87
4. 임신출산 진료비···································································93
5. 장애인보장구 ···········································································99
6. 의료급여 절차·········································································124
7. 의료급여일수 연장승인 관리 및 선택의료급여기관제도·· 128
8. 동일성분 의약품 중복투약자 관리······································153
Ⅱ. 의료급여 수급자 본인부담 완화························161
1. 본인부담 보상금제도·····························································161
2. 본인부담금 상한제·································································167
3. 의료급여 대불금 제도···························································174
4. 건강생활유지비 지원 제도····················································179
5. 중증질환자 산정특례 등록····················································186
6. 희귀난치성질환자 등록··························································190
Ⅲ. 의료급여의 제한, 변경, 중지··························196
1. 의료급여의 제한(법 제15조) ·················································196
2. 의료급여의 변경(법 제16조) ·················································198
3. 의료급여의 중지(법 제17조) ·················································199
의료급여 수급자 사례관리
Ⅰ. 개요··············································203
Ⅱ. 의료급여사례관리사업 체계···························204
1. 수행 체계················································································204
2. 의료급여관리사·······································································205
3. 예산··························································································208
Ⅲ. 의료급여사례관리 운영······························209
1. 지역유형··················································································209
2. 사례관리 대상 분류 및 정의················································209
3. 사례관리 대상자 수·······························································210
4. 사례관리 수행횟수·································································210
Ⅰ. 의료급여기금의 설치 및 관리·························213
1. 의료급여기금의 설치 및 운영··············································213
2. 의료급여비용의 예탁·····························································216
Ⅱ. 의료급여비용 지급관리·······························219
1. 의료급여비용 청구 및 심사··················································219
2. 의료급여비용 지급기준 및 순위··········································219
Ⅲ. 의료급여비용의 정산 및 결손처분······················220
1. 의료급여비용의 정산·····························································220
2. 결손처분··················································································237
의료급여 사후관리 및 권익구제
Ⅰ. 사후관리··········································243
1. 의료급여 수급권 확인업무····················································243
2. 의료급여 부정청구 신고보상금제도·····································245
3. 상해요인 조사·········································································250
4. 부당이득금 징수 및 손해배상 청구·····································259
5. 보고 및 검사···········································································280
6. 행정처분··················································································281
Ⅱ. 의료급여 권익 구제·································286
1. 권리구제··················································································286
각 종 서 식·········································· 291
1. 의료급여 연혁··········································································397
2. 의료급여 수급자 현황·····························································407
3. 양육간병 또는 보호로 인한 근로가 곤란한 수급권자
4. 2012년도 국가유공자 소득계층 등급 기준표·······················410
5. 수급권자가 급여비용을 부담하는 경우 또는 항목과 부담률···· 411
6. 희귀난치성질환상병목록(107개) ·············································412
7. 중증질환자 산정특례 대상······················································417
8. 의료급여일수 연장승인 안내··················································423
9. 업무정지처분 및 과징금부과의 기준····································424
10. 의료급여와 건강보험 제도 비교··········································427
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