A new batch of heavy health care regulations will be implemented to usher in the strongest supervision of health insurance

Medical Network February 3, February, a number of new regulations in the field of health care will be formally implemented, the medical sector will have a significant impact.
Medical Institutions ushered in the strongest supervision of medical insurance recently, the State Administration of Medical Security issued the Interim Measures for the Administration of Medical Security in Medical Institutions (hereinafter referred to as the Measures), clearly "Measures" will come into effect on February 1, 2021.
According to the website of the Medical Insurance Bureau, the Measures fully reflect the spirit of "letting go of the service", eligible medical institutions can apply for a medical insurance agreement to be included in the fixed-point management of medical insurance, and clear the basic conditions and procedures for the signing of the agreement.
At the same time, the Measures also make relevant provisions for Internet hospitals, Internet hospitals may sign agreements with the entities on which they rely and report to the regional medical insurance agencies for the record, the relevant expenses for the provision of services in accordance with the provisions shall be settled by the coordinating regional medical insurance agencies and fixed-point medical institutions.
addition, the Measures also provide that medical institutions with non-essential medical services such as medical beauty, assisted reproduction, life care, dental implantation (oral cavity) as the main scope of practice shall not accept fixed-point applications for medical insurance.
In the area of intelligent supervision of medical insurance, the Measures make it clear that if a designated medical institution refuses, obstructs or does not cooperate with the medical security department to carry out intelligent audit, performance appraisal, supervision and inspection, etc., if the circumstances are serious, the administrative department of medical security or other relevant departments in administrative law enforcement finds that there are serious violations of the law in the designated medical institutions and may cause major losses of the medical security fund, the operating institution shall lift the medical insurance agreement and publish to the public the list of medical institutions that have lifted the medical insurance agreement.
The new notice of direct settlement of general outpatient expenses across provinces came according to a notice issued by the Office of the State Medical Security Administration, Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Anhui, Chongqing, Sichuan, Yunnan, Tibet and other 11 provinces (regions, cities), as well as Guizhou Province and the southwestern Bui Hmong Autonomous Prefecture all access to the national off-site medical settlement system and connect the general outpatient expenses across the province direct settlement services.
the service will be operational from February 1, 2021.
At the same time, after examination by the State Health Insurance Administration and the Ministry of Finance, it was decided to add Shanxi Province, Inner Mongolia Autonomous Region, Liaoning Province, Jilin Province, Heilongjiang Province, Fujian Province, Jiangxi Province, Shandong Province, Hubei Province, Guangxi Zhuang Autonomous Region, Hainan Province, Shaanxi Province, Qinghai Province, Ningxia Hui Autonomous Region, Xinjiang Uygur Autonomous Region, these 15 provinces for the direct settlement of outpatient expenses across provinces pilot provinces, from February 1, 2021, to carry out direct settlement of general outpatient expenses across provinces.
Shanghai: Physicians detained 18 separate posts Shanghai Health and Health Commission also recently issued the "Shanghai Physicians Bad Practice Score Management Measures" (collectively, the "Measures"), effective February 15, 2021.
measures, Shanghai will implement the cumulative calculation of the score of bad practice of physicians.
of the doctor's bad practice is two years, which is consistent with the time of the doctor's regular appraisal cycle.
period expires, the score score for that cycle is automatically eliminated and the score for the next cycle is restarted.
The Method also clearly states that bad practice involves 12 categories, such as practice qualification, medical ethics, informed consent, privacy protection, information reporting, medical technology, medical records, prescriptions, medicines, equipment, maternal and child health care, infectious diseases, etc., and that different deductions will be dealt with to varying degrees.
, the cumulative score of bad practice of physicians reached 18 points and above, in accordance with the "Physicians Regular Assessment Management Measures" in the regular assessment of physicians failed to give the corresponding treatment.
Chuan: Internet consultation and treatment norms issued in order to further strengthen the supervision and management of Internet hospitals, regulate Internet treatment activities, Sichuan Provincial Health and Health Commission issued the "Sichuan Province Internet medical treatment management norms (trial)" (collectively, the "Code"), effective February 1, 2021.
The Code makes requests from the aspects of qualification of practice, medical behavior, medical record management, pharmaceutical services, service guarantee, supervision and inspection, and clearly does not carry out Internet consultation and treatment activities for the first patient, and once the critically ill patient or patient's condition changes are found to require on-site medical personnel to consult, it shall immediately issue a warning note to guide the patient to the physical medical institution.
The Code makes it clear that Internet hospitals shall not link any income of physicians to the amount of drugs they prescribe, strictly implement the system of price publicity and clear mark-up, establish reasonable refund standards and mechanisms, and incorporate credit information such as credit score and administrative punishment of medical institutions and personnel into the province's credit information sharing platform to achieve joint disciplinary action.
to encourage third-level hospitals to transfer patients down through the Internet consultation information system in the medical association, and to provide technical guidance and resource support for the development of Internet consultation and treatment activities in lower-level medical institutions.
22 January, the National Health and Health Commission issued the Measures for the Administration of Occupational Health Technical Service Institutions, which will take effect from February 1, 2021 (collectively, the Measures).
Measures stipulate that occupational health technical service institutions shall carry out relevant technical service activities in accordance with relevant laws and regulations and standards, truthfully record the original information of technical services, and ensure that relevant data and information are traceable.
accreditation authority shall conduct at least one assessment and inspection of the approved occupational health technical service institutions within the validity period of the accreditation.
the Measures to further refine the operation and supervision of hospitals, and to improve the practice norms and conduct of medical staff supervision.
noteworthy, the Measures also point out that the establishment of information management systems for occupational health technical service institutions, the establishment of credit files for medical and health practitioners, the recording of illegal and disreenced acts, and the disclosure to the public in accordance with the law.
then, according to the credit status, the implementation of classification supervision.
, November 5, 2020, the China Insurance Industry Association and the Chinese Physicians Association officially issued the Regulations on the Use of the Definition of Diseases for Major Illness Insurance (revised 2020).
new regulations have revised the major disease insurance policies enacted in 2007, including three major changes, including optimizing classification, increasing the number of diseases and expanding the scope of disease definition, and will come into effect on February 1, 2021.
new regulations will be the original definition of 25 kinds of serious diseases to expand to "28 kinds of serious diseases and 3 kinds of minor diseases."
Severe disease types increased the number of severe chronic respiratory failure, severe Crohn's disease, severe ulcerative colitis, and for the first time introduced a definition of mild disease, the malignant tumor, acute myocardial infarction, stroke sequelae 3 core diseases, according to the severity of the two levels of severe disease and mild disease.
In addition, the new regulations also expand the scope of protection for major organ transplantation, coronary artery bridge surgery, heart valve surgery, aortic surgery and other 8 diseases, improve and optimize the definition of serious chronic kidney failure and other 7 diseases, claims further standardized.