Interim Measures for the administration of medical consumables for basic medical insurance issued by the State Health Insurance Bureau

< br / >The document clearly points out that the administrative department of medical security under the State Council, taking into account the functional role, clinical value, cost level, medical insurance fund bearing capacity and other factors of medical consumables, adopts the access law to formulate the catalogue of medical consumables for basic medical insurance, which is updated regularly and adjusted dynamicallyThe medical consumables in < br / > < br / > < br / > < br / > catalogue of medical consumables for basic medical insurance are included in the payment scope of medical insurance fund according to the regulationsThe structure of the catalogue of medical consumables for basic medical insurance mainly includes two parts: general cases and catalogueFor example, it explains and explains the format, name, coding specification, payment scope, etcof the catalogue of medical consumables for basic medical insuranceThe contents include number, function classification, medical insurance code, payment scope, pricing unit, payment standard, determination method of payment standard, remarks, etc< br / > < br / >The document emphasizes that, except for special provisions, all local medical insurance departments shall implement the national catalogue of medical consumables for basic medical insurance and shall not adjust it without authorization< br / > < br / >< br / > < br / >, Those that can be completely replaced; < br / > < br / > < br / > < br / > < br / / > vother ones that do not meet the basic medical insurance coverage stipulated by the state< br / > < br / >< br / > < br / >, The assessed risk is greater than the income; < br / > < br / > < br / > < br / / > 3Those listed in the negative list by the relevant departments; < br / > < br / > < br / > < br / / > 4Those who enter the medical insurance directory through fraud and other illegal means; < br / > < br / > < br / > < br / > 5Those who meet the national regulations can be transferred out directly < br / > < br / > < br / > < br / > < br / > < br / > < br / > < br / > < br / > < br / > < br / > < br / > < br / / > medical consumables in the catalog will not be paid by the medical insurance fund and the patients if they have one of the following conditions < br / > < br / > Medical consumables in < br / > < br / > < br / > < br / > catalogue of medical consumables for basic medical insurance must meet the following conditions at the same time before medical insurance fund will pay < br / > < br / > Issued by the service personnel (first aid and rescue can be appropriately extended to non designated medical institutions); < br / > < br / > < br / > < br / / > v other conditions stipulated by the state < br / > For exclusive products, in principle, the first payment standard of medical insurance shall be determined through negotiation If the negotiation is successful, the medical insurance department shall pay according to the payment standard determined in the negotiation agreement If the negotiation is unsuccessful, it will not be included in the scope of medical insurance payment, and if it has been included in the catalog, it will be transferred out Negotiation rules for medical consumables shall be formulated separately < br / > < br / > < br / > < br / > for non exclusive products, in principle, the payment standard shall be determined and adjusted through centralized < br / > purchase < br / / Each provincial medical security administrative department shall determine the payment standard of medical insurance of the province (autonomous region, municipality directly under the central government) according to the result of the state, the Union and the province (autonomous region, municipality directly under the central government) with the lowest middle price of medical consumables of the same category and similar function < br / > < br / > < br / > < br / > for medical consumables not included in the scope of belt purchase, each province (autonomous region, municipality directly under the central government) shall determine the payment standard according to the calculation method of the payment standard in the catalog The rules for determining the medical consumables medical insurance payment standard shall be formulated separately < br / > < br / > < br / > < br / > < br / > in principle, the specific payment method and payment proportion of medical consumables shall be determined by the provincial medical security administrative department or the overall planning area Support all localities to include medical consumables in the catalog into the package payment scope, such as payment by disease type, payment by disease diagnosis related groups, etc < br / > < br / > < br / > < br / > < br / > this document requires that all medical consumables purchased by public medical institutions must be purchased after being linked to the provincial centralized purchase platform through the corresponding centralized purchase procedures The medical consumables for negotiation access shall be directly purchased online during the negotiation agreement period < br / > < br / > If the medical consumables code is consistent with the medical consumables code in the catalog, it will automatically belong to the payment scope of medical insurance fund, and the payment policy and rules are consistent with the medical consumables with the same code in the catalog If the coding of the medical consumables is inconsistent with that in the catalogue, the administrative department of medical security under the State Council shall organize experts to review and determine whether it is included in the catalogue of medical consumables for basic medical insurance < br / > < br / >, We will improve the level of medical consumables in basic medical insurance and safeguard the health rights and interests of the people, These measures are formulated in accordance with the spirit of the social insurance law of the people's Republic of China, the opinions of the CPC Central Committee and the State Council on deepening the reform of the medical security system (Zhongfa [2020] No 5), and the notice of the general office of the State Council on Printing and distributing the reform plan for the treatment of high value medical consumables (guoban Fa [2019] No 37) < br / > < br / > These measures are applicable to the access, payment and corresponding management and supervision of medical consumables < br / > < br / > < br / > The medical consumables in the catalogue of medical consumables for basic medical insurance are included in the payment scope of medical insurance fund according to regulations < br / > < br / > Based on the whole life cycle cost of medical consumables, highlighting the clinical value, and on the basis of strengthening the safety, effectiveness and economic evaluation, and according to the functional orientation of basic medical insurance, gradually define the payment standard of medical insurance < br / > < br / > < br / > < br / > Article 5 [classification and coding] basic medical insurance medical consumables shall be classified and coded in principle according to the principles and standards determined by the administrative department of medical security under the State Council, and adjusted appropriately according to the needs of medical insurance access management The medical consumables listed in the scope of "classification and code of medical consumables for medical security" shall be differentiated according to the material and specification based on the three-level classification < br / > < br / > For example, it explains and explains the format, name, coding specification, payment scope, etc of the catalogue of medical consumables for basic medical insurance The contents include number, function classification, medical insurance code, payment scope, pricing unit, payment standard, determination method of payment standard, remarks, etc < br / > < br / > < br / > < br / > Article 7 [division of Responsibilities] the administrative department of medical security under the State Council is in charge of the access, payment, management, classification and coding of medical consumables Responsible for establishing and improving the medical consumables medical insurance access management system, improving relevant policies, taking the lead in formulating the adjustment scheme of the medical consumables catalogue of basic medical insurance and soliciting the opinions and suggestions of the relevant departments of the State Council, issuing the national medical consumables catalogue of basic medical insurance and adjusting it regularly, and strengthening the guidance, management and supervision of all regions Determine the payment standard of exclusive products through negotiation The national medical insurance agency is entrusted by the administrative department to undertake the specific organization and implementation of the adjustment of the national catalogue of medical consumables for basic medical insurance < br / > < br / > Specifically including the development of medical consumables payment management measures according to the requirements, the determination of medical consumables payment standards in the catalog according to the procedures, and the strengthening of the guidance, management and supervision of the overall management of regional medical consumables < br / > < br / > < br / > < br / > < br / > < br / > the determination of the second chapter < br / > catalogue of medical consumables for basic medical insurance < br / > < br / > < br / > < br / > Article 8 [basic conditions for inclusion in the catalogue] medical consumables included in the payment scope of basic medical insurance should be registered or filed in the drug regulatory department according to the regulations, and have the basic conditions of clinical necessity, safety, effectiveness and economy  <b