On September 5, the State Medical Security Bureau issued the Notice of the State Medical Security Bureau on Doing a Good Job in the Management of Medical Consumables Payment for Basic Medical Insurance (hereinafter referred to as the “Notice”), which consists of 4 major parts and 15 articles. The medical consumables referred to in the Notice are those that have been registered or filed by the medical device authorities, have been granted listing status and can be charged separately.
According to the Notice, from the date of issuance of this Notice, the provinces should report to the State Medical Insurance Bureau for the record before introducing the medical consumables catalog for implementation. Provincial medical insurance departments are encouraged to take the form of regional alliance or collaboration to explore the establishment of a unified consumable catalog and payment standards within the alliance or region. The NHPA will launch the development of a national medical consumables catalog for medical insurance in due course.
The key points are summarized below:
Point 1: Promote the national unification of the classification and code of consumables
The Notice states that the classification and code of medical consumables should be unified. To solidly promote the application of the national medical insurance medical consumables code, in a timely manner in accordance with the National Health Insurance Bureau to develop the classification of medical consumables and code database to do a good job of updating the medical consumables code to improve the application of the accuracy and standardization of the medical consumables code to achieve the medical consumables with the code procurement, with the code to use, with the code billing, with the code supervision, and to ensure that the classification of medical consumables and the code of the national unity.
Point two: technology consumption separation, this kind of consumables into the medical insurance payment
The Notice points out that the scope of consumables to be included in the payment of medical insurance. To adapt to the medical service price reform “technical services and material consumption separate” principle, strengthen the medical service price project and medical consumables payment management linkage, and gradually will not be included in the medical service price composition of disposable medical consumables according to the provisions of the medical insurance payment management scope.
Point three: these consumables shall not be included in principle in the medical insurance payment
In terms of access to medical insurance, the “Notice” provides that adhere to the “basic” functional positioning. The access and management of basic medical insurance medical consumables should always firmly adhere to the “basic” functional positioning, do their best, within their means, and reasonably determine the scope of payment and payment standards, focusing on the strategic purchasing role of the medical insurance fund, will be clinically necessary, safe and effective, reasonably priced medical consumables into the scope of payment of medical insurance in accordance with the procedures. The medical consumables will be included in the scope of medical insurance payment in accordance with the program.
In principle, medical consumables with low clinical value, prices or costs far exceeding the affordability of the fund and patients, as well as non-therapeutic rehabilitation devices shall not be included in the scope of medical insurance payment. For the state explicitly required not to be included in the scope of medical insurance payment of consumables, adhere to the original provisions.
Point four: the gradual implementation of medical insurance common name management
The Notice points out that the State Medical Insurance Bureau will study the establishment of a common name management system for medical consumables under medical insurance, based on the classification and code database of medical consumables under medical insurance, determine the naming norms appropriate for the management of medical insurance payment, gradually formulate the naming rules for common names of different categories of medical consumables, and compile the common name of medical insurance as the basis for the next step in the management of medical insurance payment.
For medical consumables with common names already formulated, we should actively promote the management of medical insurance payment for medical consumables according to common names. For medical consumables that have not yet developed a common name, the current classification and code will be used for the time being for medical insurance payment management.
Point 5: “14th Five-Year” period, the establishment of the province’s unified medical insurance consumables catalog
The Notice makes it clear that the access management of medical consumables catalog is steadily advancing. Promote the establishment of a sound medical consumables access system, “14th Five-Year” period, should be completed according to the access law to develop the province (autonomous regions, municipalities directly under the Central Government) unified basic medical insurance medical consumables directory.
At this stage has established the province’s unified medical insurance medical consumables directory of the region, temporarily based on the national medical insurance medical consumables classification and code, and gradually to the medical insurance common name management transition. At this stage has not yet established the province’s unified medical supplies directory of the region to increase efforts to “14th Five-Year Plan” period to establish the province’s unified medical supplies directory.
For the more mature generic management of consumables, the state will gradually develop a unified national medical insurance catalog, and gradually expand the scope of the national catalog covered by the category of consumables.
Point 6: Establish a dynamic adjustment mechanism and explore negotiated access for exclusive consumables
According to the Notice, each province should organize medical consumables, clinical, health insurance management, technology assessment and other experts and industry-related associations, through a standardized evaluation process, the eligible medical consumables into the directory in accordance with the procedures, and the results of the evaluation will be disclosed to the public in a timely manner. Encourage the priority inclusion in the catalog of selected consumables from centralized banded purchasing that comply with the current payment policy. Explore access to exclusive or high-value products through negotiation and other means.
In addition, a sound dynamic adjustment mechanism should be established. Comprehensively consider the technological progress of medical consumables, clinical use, price and cost levels, and the affordability of the medical insurance fund and insured persons, etc., to realize the dynamic adjustment of in and out. Timely replenishment of the necessary new technology products, withdrawal of clinical can be better replaced, poor economic evaluation, by the relevant departments included in the negative list and other products do not meet the requirements of medical insurance.
At the same time, the establishment of a sound risk prevention mechanism for the adjustment of the scope of payment of medical consumables medical insurance, the safety of the fund, the treatment of patients for a long period of accurate calculations, for the possible risks of the development of a plan, especially involving the transfer of the scope of payment of the varieties of the alternative to do a good job of guaranteeing the protection of the rights and interests of patients.
Point 7: Gradually balance the payment policy within the province
The Notice points out that the payment policy should be coordinated and optimized. Promote the payment policy to be more scientific and refined, and gradually phase out the sloppy payment policy based solely on the segmented payment of the cost level, and the one-size-fits-all quota or limit payment.
The coordinated areas can take into account factors such as the fund’s affordability and the burden on the insured, and according to the actual situation of some of the higher price or cost of medical consumables to set up the first out-of-pocket payment ratio. Provincial health insurance departments should strengthen coordination, gradually balance the payment policies and protection levels of the integrated regions within the province, and encourage provinces with the conditions to realize unification on a provincial basis as early as possible.
Point 8: Establishment of DRG/DIP synergistic promotion mechanism
Promote payment standards in a steady and orderly manner. Encourage provinces to explore the development of medical consumables payment standards for medical insurance and make dynamic adjustments. Improve the synergistic mechanism between payment standards and centralized purchasing prices, and determine the payment standards for products selected in centralized band purchasing in accordance with relevant regulations. Explore access negotiations and other ways to rationally determine the payment standards for some high-value medical consumables. For medical consumables with the same function and use, similar materials and characteristics, clinical substitutability, and convergence of medical insurance management, unified payment standards can be formulated.
Synergize the payment method reform. Establishing a mechanism for synergistic promotion with DRG, DIP payment method reform and other policies to form a positive stacking effect. Consider the payment scope, payment standard and payment policy of medical consumables in an integrated manner, and improve the total budget and payment standard for disease types/groups in a timely manner.
Point nine: these consumables focus on monitoring
According to the Notice, a monitoring and evaluation mechanism for medical insurance payment should be established. Provinces regularly on the province’s medical consumables health insurance access, health insurance fund payment, patient burden, etc., as well as online procurement, online procurement rate, etc., monitoring, statistics, analysis, focusing on the clinical use of more than the fund consumption and patient burden of medical consumables to monitor the heavy burden.
Hongguan care about your health.
See more Hongguan Meidlcal consumables Product→https://www.hgcmedical.com/products/
If there are any needs of medical comsumables, please feel free to contact us.
hongguanmedical@outlook.com
Post time: Sep-11-2023