The "Basic Medical Insurance and Medical Consumables Catalog" is dynamically adjusted!

On November 19, the National Medical Insurance Administration issued an announcement for public comments on the "Interim Measures for the Management of Payment of Medical Consumables for Basic Medical Insurance (Draft for Comment)" and "Nambling Standards for the "Generic Names of Medical Insurance" Medical Consumables (Draft for Comments)"
.
Interim Measures for the Payment Management of Medical Consumables for Basic Medical Insurance (Consultation Draft) The "Interim Measures for the Management of Medical Consumables Payment Management for Basic Medical Insurance (Consultation Draft)" clarifies that medical consumables with high clinical value and excellent economic evaluation are included in the scope of medical insurance payment
.
He also stated that the provincial medical security administrative department implements the national unified medical insurance medical consumables catalog, and formulates the payment standards in the administrative area in accordance with the rules for determining the medical insurance payment standards
.
The provincial medical security administrative department is responsible for guiding and supervising the implementation of the national medical insurance medical consumables catalog and provincial payment standards in all areas under its jurisdiction
.
As early as June last year, the National Medical Insurance Administration issued the "Interim Measures for the Management of Medical Consumables for Basic Medical Insurance (Draft for Comment)" for public comments, and determined the "Catalog of Medical Consumables for Basic Medical Insurance" (hereinafter referred to as the "Catalog of Consumables")
.
The "Interim Measures for the Payment Management of Medical Consumables for Basic Medical Insurance (Draft for Comment)" released this time clarified that the "Consumables Catalog" should be dynamically adjusted, indicating that the medical consumables included in the "Consumables Catalog" must have clinically necessary, reasonable prices, and It is safe and effective, and has established a dynamic catalog adjustment mechanism to determine the scope of consumable catalog adjustment according to factors such as medical consumables protection needs, medical insurance fund revenue and expenditure, affordability, and catalog management priorities
.
In addition, in terms of medical insurance payment, the "Interim Measures for the Management of Medical Consumables Payment Management for Basic Medical Insurance (Draft for Comment)" encourages all localities to include the medical consumables in the catalog into the scope of packaged payment according to disease scores and group payments related to disease diagnosis
.
On the basis of provincial-level payment standards, each coordinating area can make a reasonable determination of the payment ratio in consideration of factors such as fund affordability
.
(1) Insured patients use medical consumables whose price is not higher than the payment standard, and each coordinating area shall determine the payment ratio based on the actual sales price
.
(2) For insured patients who use medical consumables whose prices are higher than the payment standard, each coordinating area shall comprehensively consider factors such as payment standards and fund affordability to determine the appropriate payment ratio
.
In addition, the medical security agency must maintain the overall stability of the patient's burden through fixed-point agreements and other methods to avoid excessively increasing the patient's burden
.
(1) Insured patients use consumables whose prices are higher than the payment standard, and require designated medical institutions and medical staff to guarantee the informed consent of the insured patients; (2) Provincial medical insurance departments for products with a large gap between the actual price and the payment standard Products whose online prices exceed the payment standard, and are competitive and fully supplied, can be restricted to varying degrees in the online connection and other links, until the online connection is cancelled
.
It is worth noting that the "Interim Measures for the Management of Payment of Medical Consumables for Basic Medical Insurance (Draft for Solicitation of Comments)" also stated that the national basic medical consumables payment shall be managed by the common name of medical insurance
.
On the basis of classification according to the coding rules of medical consumables of the medical security administrative department of the State Council, according to subject, use, function as the core, taking into account the material and characteristics, and fully considering the differences in the classification of different subjects, the management is based on similar functions and effects, and payment standards.
The principle of convergence is to classify and merge consumables with codes for medical insurance consumables to form a generic name for medical insurance
.
Medical insurance medical consumables "Medical insurance generic name" naming standard (draft for comments) Uniform and standardized naming of convergent medical consumables
.
The "Medical Insurance Generic Name" is used for national medical insurance medical consumables catalog entry, online procurement, medical insurance payment and fund supervision
.
The naming of "Medical Insurance Generic Name" is based on the classification of medical insurance medical consumables (three-level classification + common name + material and characteristics).
In principle, the three-level classification name is prefaced, and necessary materials and characteristic parameters are selected according to the needs of medical insurance management to form " Generic name for medical insurance"
.
For example: the three-level classification of vascular interventional materials "coronary artery drug-eluting stent", whichever is necessary material characteristics, "medical insurance generic name" is named "coronary artery drug stent (alloy)"
.
(1) The naming of the "Medical Insurance Generic Name" shall be in Chinese and conform to the national language and writing standards
.
There must be no information such as brand trademarks, patent names, etc.
; there must not be conceptual information that has not been scientifically proven or clinically evaluated, or is empty or hypothetical; there must be no other content prohibited by laws and regulations
.
(2) The "three-level classification" of the medical insurance medical consumables coding standard has the same functions and uses, similar materials and features, clinically replaceable, and similar clinical values, and the same "medical insurance generic name" should be used for the same medical insurance management
.
For example: Fully covered and partially covered Nitinol esophageal stents, regardless of material, "medical insurance generic name" is "esophageal stent (covered)"
.
(3) Varieties that combine two or more medical consumables to achieve a certain clinical intended use.
The "medical insurance generic name" is named with the kit name + component name as the key word, reflecting the complete clinical intended use
.
For example: Orthopedics kit product "Medical Insurance Generic Name" is named "First Hip Joint Integrated Femoral Stem (Bone Cement Type)"
.
(4) "Medical Insurance Generic Name" is the key information for complete identification of medical consumables, and the characteristic information concerned by medical insurance management shall not be defaulted
.
Based on the registration and record information of the medical insurance medical consumables database, with the primary classification as the main line, based on the functions and clinical characteristics of medical consumables, and drawing on the naming rules of the medical device general names of the State Drug Administration, the naming rules of "medical insurance general names" are classified and compiled
.
In accordance with the requirements of specialized consumables to obey general consumables, and the names of single items obey the requirements of general names, comprehensive coverage, and avoidance of repetition, so as to achieve uniformity within major categories and coordinated connection between major categories
.
For example, the two medical consumable products "tracheal stent for endoscopy" and "tracheal stent for guide wire", according to the principle of convergence of product material characteristics, the "common name of medical insurance" are both "tracheal stent (metal/covered)"
.