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The "Medical Security Law" will land!

 Last Update: 2021-06-30
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　　Head record

　　The first chapter always is

　　Chapter II Fundraising and Treatment

　　Chapter III Fund Management

　　Chapter IV Medical Services

　　Chapter V Public Management Services

　　Chapter VI Supervision and Administration

　　Chapter VII Legal Liability

　　Chapter VIII attached to the

　　The first chapter always is

　　Article 1 In order to regulate the medical security relationship, improve the high-quality multi-level medical security system, safeguard the citizens' legal rights and interests in medical security, and promote the healthy development of medical security, this law is formulated in accordance with the Constitution
.

　　Article 2 The state establishes a medical security system with basic medical insurance as the main body, medical assistance as the foundation, supplementary medical insurance, commercial health insurance, and charity medical assistance, which are mutually connected and developed together
.

　　Article 3 This Law shall apply to the activities of fund-raising operations, benefit payment, fund management, price management, bidding and procurement, medical services, public management services, supervision and management related to medical security within the territory of the People's Republic of China
.

　　Article 4 The medical security undertakings shall adhere to the people's health as the center, follow the principles of covering the whole people, urban and rural areas, clear powers and responsibilities, appropriate security, and sustainable multi-level principles to continuously meet the needs of citizens for medical security
.

　　Article 5 People's governments at or above the county level shall strengthen leadership over medical security work, incorporate medical security undertakings into national economic and social development plans, establish a sound medical security system, strengthen medical security capacity building, and provide security for medical security work
.

　　Article 6 The medical security administrative department of the State Council shall be responsible for the management of medical security throughout the country, and other relevant departments of the State Council shall be responsible for relevant medical security within the scope of their respective duties
.

　　The medical security administrative department of the people's government at or above the county level is responsible for the medical security management of its administrative area, and other relevant departments of the people's government at or above the county level are responsible for related medical security within their respective responsibilities
.

　　The township (town) people's government and sub-district offices shall do a good job of medical security in accordance with the requirements of the higher-level people's government
.
The village (neighborhood) committee assists in the work related to medical security
.

　　Article 7 The state encourages localities to raise funds through multiple channels according to their own economic development level, fund affordability, population aging degree and other factors to ensure the steady and sustainable financing of medical security funds
.

　　Article 8 Medical institutions, pharmaceutical business units (hereinafter collectively referred to as medical institutions), commercial insurance companies, medical and health industry associations and other institutions shall strengthen industry self-discipline and promote industry standards and self-discipline
.

　　Article 9 Citizens have the right and obligation to participate in basic medical insurance in accordance with the law, and enjoy corresponding medical insurance treatments in accordance with regulations
.
Citizens should improve their health literacy and strengthen health management
.

　　Article 10 The State vigorously trains medical security talents and establishes a system for professional titles of medical security talents
.

　　Organizations and individuals that have made outstanding contributions to medical security will be commended and rewarded in accordance with national regulations
.

　　Article 11 The state encourages and supports foreign exchanges and cooperation in the field of medical security
.
In carrying out medical security exchanges and cooperation activities with foreign countries, laws and regulations shall be abided by, and national sovereignty, security and social public interests shall be safeguarded
.

　　Chapter II Fundraising and Treatment

　　Section 1 Basic Medical Insurance

　　Article 12 Basic medical insurance includes basic medical insurance for employees and basic medical insurance for urban and rural residents
.

Employers such as 　　state organs, enterprises , institutions, social organizations, individual industrial and commercial households with hired workers, and their employees shall participate in the basic medical insurance for employees
.

　　Persons who have not participated in the basic medical insurance for employees or have not enjoyed other medical insurance in accordance with regulations shall participate in the basic medical insurance for urban and rural residents in accordance with the law
.

　　Encourage unemployed self-employed industrial and commercial households, part-time employees who are not in the employer’s basic medical insurance for employees, and other flexible employees (hereinafter collectively referred to as flexible employees) to participate in the basic medical insurance for employees
.

　　Participants are not allowed to participate in the basic medical insurance repeatedly
.

　　Article 13 The basic medical insurance premiums for employees shall be paid jointly by the employer and the employees, and a unified withholding and payment system shall be implemented by the employer
.
For flexible employees who participate in the basic medical insurance for employees as an individual, the basic medical insurance premiums shall be paid by the individual
.

　　The basic medical insurance premiums for urban and rural residents shall be borne jointly by finance and individuals
.
Those who enjoy the minimum living allowance, those who are included in the scope of assistance and support for the extremely poor, the disabled who are incapacitated, the elderly and minors of low-income families over 60 years of age, and other individuals who participate in the basic medical insurance for urban and rural residents are required to pay for the personal payment.
Subsidies are provided by the government
.
Persons with multiple identities shall be subsidized in accordance with the highest remuneration that can be enjoyed, and the subsidy shall not be repeated
.

　　The specific policies for the financing of basic medical insurance shall be formulated by the medical security administrative department of the State Council
.

　　Article 14 The starting time for the benefits of basic medical insurance participants after payment shall be implemented in accordance with the relevant regulations of the state and various provinces, autonomous regions, and municipalities directly under the Central Government
.

　　For individuals who participate in the basic medical insurance for employees, when the basic medical insurance relationship is transferred and continued, the basic medical insurance payment period will be calculated cumulatively
.

　　Article 15 The payment scope of the basic medical insurance fund shall be organized and formulated by the medical security administrative department of the State Council
.

　　The people's governments of provinces, autonomous regions, and municipalities directly under the Central Government shall, in accordance with relevant national regulations, supplement the specific items and standards for basic medical insurance fund payment in their administrative regions, and report them to the medical security administrative department of the State Council for the record
.

　　The medical security administrative department of the State Council is responsible for organizing the formulation of the national basic medical insurance drugs, medical consumables, medical service items, medical service facilities and other catalogs and payment standards, and implementing dynamic adjustments
.

　　Article 16 The following medical expenses are not included in the payment scope of the basic medical insurance fund:

　　 (1) It should be paid from the work-related injury insurance fund;

　　 (2) Should be borne by a third person;

　　 (3) Should be borne by public health;

　　 (4) Seeking medical treatment abroad;

　　 (5) Sports fitness, health care consumption, and health check-ups;

　　 (6) Other expenses not paid by the basic medical insurance fund prescribed by the state
.

　　When encountering a major impact on economic and social development, the scope of non-payment of the basic medical insurance fund can be adjusted temporarily after legal procedures
.

　　Article 17 Expenses incurred by persons participating in basic medical insurance in designated medical institutions that meet the scope of basic medical insurance payment shall be paid by the basic medical insurance fund in accordance with regulations
.

　　Article 18 Employing units and employees shall participate in maternity insurance.
The maternity insurance premiums shall be paid by the employers in accordance with regulations, and individual employees shall not pay
.
Maternity insurance benefits include maternity medical expenses and maternity allowances
.
Maternity insurance and basic medical insurance for employees shall be implemented in combination in accordance with state regulations
.

　　The maternity medical expenses incurred by women who have not participated in maternity insurance shall be resolved by participating in basic medical insurance
.

　　Section 2 Multi-level medical insurance

　　Article 19 The people's government at or above the county level shall improve the medical assistance system, and implement subsidized insurance and direct medical expenses assistance for people in difficulty who meet the conditions for medical assistance
.
Medical assistance objects, assistance methods, and scope of assistance expenses shall be implemented in accordance with relevant national regulations
.
The medical aid fund is raised through multiple channels such as financial subsidies, lottery charity funds, and social donations
.
The people's government at or above the county level shall scientifically and reasonably determine the medical aid standards based on the level of economic and social development and the raising of medical aid funds
.

　　Article 20 Supplementary medical insurance mainly includes major illness insurance for urban and rural residents, subsidies for large amounts of medical expenses for employees, medical subsidies for civil servants, and supplementary medical insurance for enterprises
.
Supplementary medical insurance guarantees the medical expenses that meet the requirements of the insured persons who are personally borne by the basic medical insurance
.

　　Article 21 Encourage the development of commercial health insurance and support commercial insurance companies to expand the scope of insurance products such as critical illness insurance
.
Encourage employers and urban and rural collective economic organizations to purchase commercial health insurance for their employees and members in accordance with regulations
.
The medical security administrative department of the State Council, in conjunction with relevant departments, regulates the management of commercial health insurance, and promotes the orderly development of commercial health insurance
.

　　Article 22 The state encourages social charitable donations to support the development of medical security
.
Coordinate and mobilize the assistance of charity medical assistance to support the orderly development of medical mutual assistance
.
The collection and use of charity medical assistance funds shall be implemented in accordance with relevant national regulations
.

　　Article 23 The State establishes and develops long-term care insurance to address the basic care security needs of disabled persons
.
Long-term care insurance covers all people, the payment is reasonably shared, the protection is balanced and moderate, and the level of financing and benefits are dynamically adjusted
.
Formulate and improve standards for disability assessment and needs identification, the scope of basic insurance items, and management methods that are compatible with the operation of the long-term care insurance system
.
Improve the service system that meets the characteristics of long-term care insurance
.
Support social forces to participate in the construction of the institutional system and encourage the establishment of a diversified comprehensive security structure
.

　　Article 24 The state shall improve the mechanism for guaranteeing medical treatment expenses in emergencies such as major epidemics, improve the medical treatment and medical insurance payment policy, and make overall plans for the use of medical security funds and public health service funds
.

　　Chapter III Fund Management

　　Article 25 The medical security fund shall implement the financial accounting system prescribed by the state, and shall conduct accounting in accordance with the accounting system prescribed by the state
.
Medical security agencies should strengthen fund management in accordance with regulations, and administrative departments such as finance and medical security should strengthen supervision
.

　　The basic medical insurance fund shall be deposited in a special fiscal account
.

　　Article 26 The medical security fund is earmarked for use only, and no organization or individual may embezzle or misappropriate it
.

　　Article 27 The medical security fund shall strengthen budget management and implement the budget and final accounts system
.

　　The people's government at or above the county level shall continue to improve the guarantee mechanism of the basic medical insurance fund and medical assistance fund, and fully implement the supporting fund-raising responsibilities in accordance with the budget implementation
.

　　Article 28 The State establishes a national medical security risk management and control mechanism, and establishes a national medical security risk adjustment fund, which consists of central fiscal budget appropriations and funds raised by other means approved by the State Council, and is used to supplement and adjust medical security expenditures
.

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　　Article 33 The basic medical services provided by public medical institutions are subject to government-guided prices, and non-basic medical services such as special needs are subject to market-adjusted prices
.
Medical services provided by non-public medical institutions are subject to market-adjusted prices
.
The prices of medicines and medical consumables with market-adjusted prices in accordance with the law, as well as medical services, shall be set in accordance with the principles of fairness, legality, quality and price, and honesty and trustworthiness
.

　　Medical institutions shall publicize the prices of medicines, medical consumables and medical services in a clear and clear manner, strengthen the management of the rational use of medicines and medical consumables, truthfully issue expense receipts and related materials, and accept price monitoring, guidance, inspection and cost from medical security and other departments Investigate
.

　　Article 34 The medical security administrative department is responsible for conducting cost price surveys of drugs and medical consumables, implementing a credit evaluation system for drug prices and bidding purchases, and strengthening the supervision and inspection of illegal acts infringing on the medical security fund by means of price monopoly and price bidding.

.

　　The medical security administrative department shall establish a mechanism for macro-management, classified management, dynamic adjustment, monitoring and assessment of medical service prices, determine the procedures for setting and adjusting prices of medical services, and carry out medical service price monitoring, guidance, inspection, cost investigation and assessment for medical institutions
.

　　Article 35 The medical security administrative department of the State Council is responsible for formulating medical security service agreements (hereinafter referred to as service agreements) management measures, standardizing, simplifying, and optimizing medical institutions' designated application, professional evaluation, and negotiation procedures, and preparing and regularly revising service agreement templates
.

　　The State Council administrative department of health care service agreement management measures, shall hear the terms of the relevant departments, medical institutions, industry associations, the public, experts and other opinion
.

　　Article 36 In accordance with the needs of protecting public health and management services, medical security agencies and medical institutions establish collective bargaining and consultation mechanisms, negotiate and sign service agreements, clarify the rights and obligations of both parties, regulate medical service behaviors, and clarify violations of service agreements Behavior and its responsibilities
.

　　The medical security agency shall promptly announce to the public the list of medical institutions that have signed service agreements
.

　　Article 37 Designated medical institutions shall provide reasonable and necessary medical services for insured persons, implement price policies that meet the requirements, improve service quality, use medical security funds rationally and effectively, and safeguard citizens' health rights and interests
.
On the premise of meeting clinical needs, designated medical institutions should give priority to the use of medical service items that can be paid by the medical security fund
.

　　Article 38 The designated medical institution shall establish an internal management system for the medical security fund, and a special agency or personnel shall be responsible for the management of the medical security fund, and establish a sound assessment and evaluation system
.

　　The designated medical institution shall organize training on the relevant systems and policies of the medical security fund, regularly inspect the use of the medical security fund of the unit, and promptly correct the irregular use of the medical security fund
.

　　Article 39 The medical security departments at all levels shall organize and carry out the medical security performance assessment of designated medical institutions and establish a dynamic management mechanism
.
The performance appraisal method is formulated by the medical security department of the State Council, the provincial medical security department may formulate specific assessment rules, and the handling agency is responsible for organizing the implementation
.

　　Article 40 Designated medical institutions shall keep accounting vouchers, medical records, prescriptions and other materials in accordance with regulations, timely and comprehensively and accurately transmit medical security related data through the medical security information system, report required information to the medical security administrative department, and disclose medical expenses, Information such as cost structure is subject to social supervision
.

　　Article 41 Pharmaceutical companies, medical institutions and their staff are prohibited from giving or receiving kickbacks or seeking other illegitimate benefits during the purchase and sale of drugs and medical consumables
.

　　Administrative departments such as medical security, medical security agencies, medical insurance premium collection departments, designated medical institutions and their staff shall not accept bribes or obtain other illegal income
.

　　Chapter V Public Management Services

　　Article 42 The State shall establish and improve a unified national medical security handling and management system
.
Coordinate the establishment of medical security agencies in regions, and set up branches and service outlets according to work needs, strengthen the allocation of medical security public management service capabilities, and realize all provinces, cities, counties, towns (subdistricts), and villages (communities) medical security public services Covered
.

　　The expenses required for the provision of public services for medical security shall be guaranteed by the finance at the same level in accordance with national regulations
.

　　Article 43: A medical security agency that provides medical security agency services shall establish and improve business, financial, security and risk management systems, and be responsible for insurance registration, personal rights and interests records, medical insurance relationship transfer and continuation processing, agreement management, and expense monitoring , Fund appropriation, treatment review and payment, handling audits, off-site medical treatment and medical expenses settlement management
.

　　Article 44 The medical security agency shall promptly establish files for the insured units and individuals, complete and accurately register the information of the insured persons, and record the rights and interests of individuals enjoying medical security benefits
.

　　The medical insurance premium collection department shall collect medical insurance premiums in accordance with relevant state regulations, complete and accurately record the payment information of the insured persons, etc.
, and report to the medical security agency in a timely manner
.

　　Medical security agencies and medical insurance premium collection departments obtain data required for medical security work through business management, fee collection, statistics, and surveys.
Relevant units and individuals shall provide timely and truthful data
.

　　Employers have the right to inquire about their payment records, and insured persons have the right to inquire about personal rights and interests records, and require medical insurance agencies to provide medical insurance consultation and other related services
.
Individuals have the right to supervise the payment status of their units
.

　　Article 45 Both designated medical institutions and medical security agencies shall perform service agreements
.
The medical security agency shall manage, supervise and evaluate the implementation of the service agreement of the medical institution
.

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　　Chapter VI Supervision and Administration

　　Article 49 The standing committees of the people’s congresses at all levels listen to and review special work reports of the people’s governments at the same level on the income and expenditure, management, investment and operation, supervision and inspection of the medical security fund, and organize law enforcement inspections on the implementation of this law, etc.
, Exercising supervisory powers in accordance with the law
.

　　Article 50 The medical security administrative department of the people's government at or above the county level shall strengthen the supervision and inspection of the compliance of relevant units and individuals with medical security laws and regulations
.

　　The medical security administrative department shall strengthen the supervision of medical service behaviors and medical expenses included in the payment scope of the medical security fund, regulate medical service behaviors, and investigate and punish illegal use of the medical security fund in accordance with the law
.
The medical security administrative department shall establish and improve a medical security credit evaluation system for designated medical institutions, personnel, medical prices, and centralized bidding and procurement, and manage it according to the level of credit evaluation
.

　　When the medical security administrative department conducts supervision and inspection, the units and individuals inspected shall truthfully provide materials related to medical security, and shall not refuse the inspection or make false or concealed reports
.

　　Article 51 The medical security administrative department shall conduct supervision and inspection in accordance with the law and find that there are problems, it shall propose rectification suggestions, make a handling decision in accordance with the law, or transfer it to the relevant administrative department for handling
.
The results of inspections should be regularly announced to the public
.

　　The medical security administrative department has the right to take the following measures to implement supervision and inspection:

　　 (1) Consult, record, copy and supervise and inspect relevant materials;

　　 (2) Use information technology to carry out real-time monitoring and retrieve data from relevant information systems;

　　 (3) Seal up or seize materials that may be transferred, concealed, or lost, or that there is preliminary evidence to prove that they may be transferred, concealed, or lost;

　　 (4) Inquiring about units and individuals related to the investigation items, requesting them to explain the issues related to the investigation items and provide relevant supporting materials;

　　 (5) Hiring qualified accounting firms and other third-party institutions and professionals to assist in the inspection;

　　 (6) To stop the concealment, transfer, embezzlement, or misappropriation of the medical security fund and order it to be corrected;

　　 (7) Other measures that can be taken according to law
.

　　Article 52: Administrative departments such as medical security, medical security handling agencies, medical insurance premium collection agencies, medical institutions, information system developers, and other institutions and their staff shall not share state secrets and work secrets obtained or known in their work.
, The data or related information of the subject under investigation is used for purposes other than supervision and management, and shall not be disclosed, tampered with, destroyed, or illegally provided to others the personal information and business secrets of the party concerned
.

　　Article 53 Where an employer or individual believes that the actions of the medical insurance premium collection department infringe upon their lawful rights and interests, they may apply for administrative reconsideration or file an administrative lawsuit in accordance with the law
.

　　Employers or individuals may apply for administrative reconsideration or file an administrative lawsuit against medical security agencies that fail to register for insurance, pay medical security benefits, or infringe other medical security rights and interests in accordance with the law
.

　　Pharmaceutical companies that fail to implement established transaction rules and standards against provincial-level centralized procurement agencies, or abuse centralized procurement powers, can file a complaint with the medical security administrative department
.

　　Pharmaceutical companies may apply for arbitration and file a lawsuit in accordance with the law for non-payment of drugs and medical consumables in a timely manner as agreed in the purchase and sale agreement
.

　　Article 54 Any organization or individual has the right to report and complain about violations of the medical security fund
.

　　The medical security administrative department shall unblock the reporting and complaint channels, deal with the related reports and complaints in a timely manner in accordance with the law, and keep the informant's information confidential
.
For reports verified to be true, the reporter will be rewarded in accordance with relevant state regulations
.

　　Chapter VII Legal Liability

　　Article 55 If the medical insurance premium collection department arbitrarily changes the base and rate of medical insurance premium payment, resulting in an underpayment or overcharge of medical insurance premiums, the relevant administrative department shall order it to recover the medical insurance premiums that should be paid or return the medical insurance premiums that should not be paid.
Medical insurance premiums; the directly responsible persons in charge and other directly responsible persons shall be punished according to law
.

　　Article 56 Anyone who infringes on the provisions of this law by embezzling or embezzling the medical security fund shall be ordered by the medical security and other administrative departments to recover; if there are illegal gains, the illegal gains shall be confiscated; the directly responsible persons in charge and other directly responsible persons shall be granted according to law Sanction
.

　　Article 57: If a centralized procurement agency has any of the following circumstances, the medical security administrative department shall order corrections, and the directly responsible persons in charge and other directly responsible persons shall be punished according to law; if the medical security fund is lost, it shall be ordered to be returned; otherwise In the case of laws and administrative regulations, the relevant competent departments shall impose penalties according to law:

　　 (1) Failing to implement transaction rules and standards such as listing and withdrawal of the centralized procurement platform;

　　 (2) Abusing the power of centralized procurement, restricting market competition or causing unfair competition;

　　 (3) Seeking illegitimate benefits in the process of centralized procurement;

　　 (4) Other illegal acts in the centralized procurement process
.

　　Article 58: Pharmaceutical enterprises in any of the following circumstances shall be ordered by the medical security administrative department to make corrections and confiscate their illegal income; if the bid is won, the bid won is invalid, and a fine of 5‰ to 10‰ of the amount of the winning project shall be imposed; the legal representative, The main person in charge, the directly responsible person in charge and other responsible persons shall impose a fine of 5% or more and less than 10% of the fine of the unit; if the circumstances are serious, restrict or suspend the qualification of relevant pharmaceutical companies or relevant drugs and medical consumables to participate in centralized procurement and be given Announcement; Violation of other laws and administrative regulations shall be punished by the relevant competent department according to law:

　　 (1) Bidding at a price lower than the cost, or bidding through fraud, bid collusion, abuse of market dominance, etc.
;

　　 (2) Offering bribes to medical security agencies, centralized procurement agencies, designated medical institutions and their staff;

　　 (3) After winning the bid, waive the qualification for selection without proper reason, fail to sign the purchase and sale agreement in time, fail to fulfill the supply promise, fail to supply the goods in accordance with the agreement and relevant laws and regulations;

　　 (4) Other illegal acts in the bidding process
.

　　Article 59 If a medical security agency fails to establish a sound internal management system and fails to perform its statutory duties, the medical security administrative department shall order it to make corrections, and the directly responsible persons in charge and other directly responsible persons shall be punished according to law
.

　　Article 60: Where the staff of the medical security agency defrauds the medical security fund expenditure, the medical security administrative department shall order the refund and impose a fine of more than 2 times and less than 5 times the amount defrauded.
The directly responsible persons in charge and other directly responsible persons shall be imposed in accordance with the law.
Give sanctions
.

　　Article 61: If a designated medical institution has failed to establish an internal management system for the medical security fund, or fails to interface with the medical security information system in accordance with regulations, the medical security administrative department shall order corrections and may interview the relevant person in charge; refuse Those who make corrections shall be fined not less than 10,000 yuan but not more than 50,000 yuan; violations of other laws and administrative regulations shall be dealt with by the relevant competent authorities in accordance with the law
.

　　Article 62: If a designated medical institution has irregular use of the medical security fund, the medical security administrative department shall order it to make corrections and may interview the relevant person in charge; if the medical security fund is lost, it shall be ordered to be returned, and the amount of the loss caused shall be doubled A fine of 2 times the above; if it refuses to make corrections or causes serious consequences, the designated medical institution shall be ordered to suspend the medical services used by the medical security fund for 6 months to 1 year by the relevant responsible department; for violations of other laws and administrative regulations, the relevant The competent department shall deal with it according to law
.

　　Article 63: Where designated medical institutions and their staff defraud medical security fund expenditures, the medical security administrative department shall order the refund and impose a fine of more than 2 times and less than 5 times the amount defrauded; order the designated medical institutions to suspend relevant responsible departments for 6 months The above 1 year or less involves medical services used by the medical security fund until the service agreement is terminated by the medical security agency; if there is a qualification, the relevant competent authority shall revoke the qualification in accordance with the law
.

　　Article 64 If a designated medical institution violates the provisions of this law and causes major losses to the medical security fund or other serious adverse social impacts, the medical security administrative department shall deal with its legal representative or main person in charge to obtain income from the unit in the previous year A fine of more than 50% but not more than one time is imposed, and the management activities of designated medical institutions are prohibited within 5 years, and the relevant departments shall impose sanctions in accordance with the law
.

　　Article 65: Where an individual commits acts such as handing over his medical security certificate to others for false use, re-enjoying medical insurance benefits, etc.
, the medical security administrative department shall order correction; if it causes loss of medical security fund, it shall be ordered to return; if it belongs to the insured person , Suspend its online settlement of medical expenses for 3 months to 12 months
.

　　Where an individual defrauds the expenditure of the medical security fund, in addition to processing in accordance with the provisions of the preceding paragraph, the medical security administrative department shall also impose a fine of two to five times the amount defrauded
.

　　Article 66: Administrative departments such as medical security, medical security handling agencies, medical insurance premium collection agencies, medical institutions, information system developers and other institutions and their staff shall disclose, tamper with, damage, or illegally provide state secrets to others, For work secrets, personal information, or business secrets, the directly responsible person in charge and other directly responsible persons shall be punished according to law; violations of other laws and administrative regulations shall be dealt with by the relevant competent department according to law
.

　　Article 67: State functionaries who abuse their powers, neglect their duties, or engage in malpractices for personal gains in medical security work shall be punished in accordance with the law
.

　　Article 68 Anyone who violates the provisions of this law and constitutes a crime shall be investigated for criminal responsibility in accordance with the law
.

　　Anyone who violates the provisions of this law and causes losses to relevant entities or individuals shall be liable for compensation in accordance with the law
.

　　Chapter VIII attached to the

　　Article 69: The specific measures for participating in medical insurance for persons from outside the People's Republic of China who are employed, live, or study within the territory of the People's Republic of China shall be implemented in accordance with the relevant regulations of the state
.

　　Article 70 This law shall come into force on year, month and day
.

　　Medical Network, June 16 News On June 15, the National Medical Security Administration issued the "Announcement on the Public Consultation on the Medical Security Law (Draft for Comment)" to thoroughly implement the 19th National Congress of the Communist Party of China on the comprehensive establishment of medical security with Chinese characteristics.
The decision-making and deployment of the system will accelerate the formation of a legal and regulatory system that is in line with the reform of medical security and is conducive to the qualitative improvement of the system
.

　　The "Medical Security Law" aims to bring medical security into the track of legalization, in which strict supervision of the use of medical insurance funds has been continuously increased, so as to better establish the right of all people to enjoy medical security in a fair and just way.
This can effectively regulate the "three medical "Efficient linkage, standardizing and long-term restraint of medical insurance and related parties' behavior, and then realizing the standardized and orderly operation of the medical insurance system
.

　　The "Medical Security Law" is imperative

　　Compliance upgrade of designated medical institutions

　　The formulation of the "Medical Security Law" has always attracted the attention of the industry
.
As early as during the Third Session of the 13th National People's Congress, Zheng Gongcheng, a member of the Standing Committee of the National People's Congress, vice chairman of the Central Committee of the Democratic League, and chairman of the Chinese Society of Social Security, submitted a proposal on enacting a medical security law as soon as possible
.

　　In addition, during the National People’s Congress, Hu Jiqiang, chairman of Kang Enbei, put forward the "Recommendations on Speeding up the Legislative Process of the Medical Security Law of the People’s Republic of China" and suggested that the National People’s Congress formulate the Medical Security Law of the People’s Republic of China as soon as possible.
"To improve China's basic medical security system, security methods, operating mechanisms and management methods
.

　　In August last year, the National Medical Security Administration responded to the “Response of the National Medical Security Administration to Recommendation No.
5326 of the Third Session of the Thirteenth National People’s Congress” on its official website.
Recommendations on Legislative Procedures, the National Medical Security Administration is actively promoting the legislative work of the Medical Security Law
.

　　The "Medical Security Law (Draft for Comment)" issued this time puts forward four legal responsibilities for designated medical institutions, and the penalties for violations of the use of medical insurance funds are further clarified and strengthened:

　　Article 61: If a designated medical institution has failed to establish an internal management system for the medical security fund, or fails to interface with the medical security information system in accordance with regulations, the medical security administrative department shall order corrections and may interview the relevant person in charge; refuse Those who make corrections shall be fined not less than 10,000 yuan but not more than 50,000 yuan; violations of other laws and administrative regulations shall be dealt with in accordance with the law by the relevant competent authorities
.

　　Article 63: Where designated medical institutions and their staff defraud medical security fund expenditures, the medical security administrative department shall order the refund and impose a fine of more than 2 times and less than 5 times the amount defrauded; order the designated medical institutions to suspend the relevant responsible departments for 6 months The above one year or less involves medical services used by the medical security fund until the service agreement is terminated by the medical security agency; if there is a qualification, the relevant competent authority shall revoke the qualification in accordance with the law
.

　　Article 64 If a designated medical institution violates the provisions of this law and causes major losses to the medical security fund or other serious adverse social impacts, the medical security administrative department shall deal with its legal representative or main person in charge to obtain income from the unit in the previous year A fine of more than 50% but not more than one time, and the management activities of designated medical institutions are prohibited within 5 years, and the relevant departments shall impose sanctions according to law
.

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。

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。

　　2020，，62.
7，40.
1，6008、5457、286；2.
61，3162、2062；223.
1
。

　　Following the recovery of tens of billions of medical insurance funds in the national crackdown on insurance fraud in 2020, the supervision of medical insurance funds has ushered in another upgrade
.
On May 1, 2021, the "Regulations on the Supervision and Administration of the Use of Medical Insurance Funds" were implemented as the first regulatory regulations in the field of medical insurance.
The implementation of the regulations means that the supervision of medical insurance funds will be strengthened, and the use of medical insurance funds is clearly distinguished.
The "red line"
.

　　On April 30, the Beijing Municipal Medical Insurance Bureau's WeChat public account "Medical Insurance Beijing" reported 12 typical cases of fraudulent insurance fraud, and severely punished units and individuals for fraudulent insurance
.
Cases involving over-prescription of drugs for the treatment of chronic diseases, lending social security cards for others to use, holding others’ social security cards for medical treatment and prescribing drugs, purchasing/selling medical insurance drugs at high prices, the relevant medical institutions and insured persons involved were suspected of fraud and illegal business operations Crime, was lifted from the medical insurance agreement or transferred to the judicial authority
.

　　In addition, the "Medical Security Law" emphasizes the further establishment of a centralized procurement system for drugs and medical consumables in public medical institutions, and reiterates the main responsibility of pharmaceutical companies, and severely penalizes companies that violate regulations and laws:

　　Article 32 Pharmaceutical companies participating in the bidding shall follow the principles of fairness, lawfulness, honesty and credibility, and conform to the quality and price, set prices reasonably, and shall not bid at a price lower than the cost, and shall not use fraud, bid collusion, abuse of market dominance, etc.
Bidding
.
Pharmaceutical companies that have won the bid shall ensure the safety, effectiveness and quality controllability of drugs and medical consumables, sign purchase and sale agreements in a timely manner, and ensure the supply and distribution in place in accordance with the requirements of the purchase and sale agreement
.

　　Market participants expect that the reform of medical insurance and volume purchases have fully demonstrated the will of the country, the reform of medical insurance payment methods continues to deepen, the supervision of the use of medical insurance funds is strengthened, and the policy scope is expanded to hospitals and hospitals.
The profit and category of the channel market will encounter huge impacts.
The era of barbarous growth of medical insurance "overflowing water" is gone forever
.

　　Medical Security Law (Draft for Solicitation of Comments)

　　Head record

　　The first chapter always is

　　Chapter II Fundraising and Treatment

　　Chapter III Fund Management

　　Chapter IV Medical Services

　　Chapter V Public Management Services

　　Chapter VI Supervision and Administration

　　Chapter VII Legal Liability

　　Chapter VIII attached to the

　　The first chapter always is

　　Article 10 The State vigorously trains medical security talents and establishes a system for professional titles of medical security talents
.

　　Organizations and individuals that have made outstanding contributions to medical security will be commended and rewarded in accordance with national regulations
.

　　Chapter II Fundraising and Treatment

　　Section 1 Basic Medical Insurance

　　Article 12 Basic medical insurance includes basic medical insurance for employees and basic medical insurance for urban and rural residents
.

　　Participants are not allowed to participate in the basic medical insurance repeatedly
.

　　The specific policies for the financing of basic medical insurance shall be formulated by the medical security administrative department of the State Council
.

　　Article 15 The payment scope of the basic medical insurance fund shall be organized and formulated by the medical security administrative department of the State Council
.

　　Article 16 The following medical expenses are not included in the payment scope of the basic medical insurance fund:

　　 (1) It should be paid from the work-related injury insurance fund;

　　 (2) Should be borne by a third person;

　　 (3) Should be borne by public health;

　　 (4) Seeking medical treatment abroad;

　　 (5) Sports fitness, health care consumption, and health check-ups;

　　 (6) Other expenses not paid by the basic medical insurance fund prescribed by the state
.

　　When encountering a major impact on economic and social development, the scope of non-payment of the basic medical insurance fund can be adjusted temporarily after legal procedures
.

　　The maternity medical expenses incurred by women who have not participated in maternity insurance shall be resolved by participating in basic medical insurance
.

　　Section 2 Multi-level medical insurance

　　Chapter III Fund Management

　　The basic medical insurance fund shall be deposited in a special fiscal account
.

　　Article 26 The medical security fund is earmarked for use only, and no organization or individual may embezzle or misappropriate it
.

　　Article 27 The medical security fund shall strengthen budget management and implement the budget and final accounts system
.

　　Article 29 On the premise of ensuring safety, the medical security fund shall maintain and increase its value by investing and operating in accordance with the regulations of the State Council
.

　　Article 30 The medical security agency shall regularly announce the income, expenditure, and balance of the medical security fund to the public, and accept social supervision
.

　　Chapter IV Medical Services

　　Article 31 The State establishes a centralized procurement system for medicines and medical consumables in public medical institutions
.
The medical security administrative department formulates and supervises the implementation of bidding procurement policies for drugs and medical consumables , and guides the construction of a centralized procurement platform for drugs and medical consumables
.

　　The provincial medical security administrative department organizes public medical institutions within its jurisdiction to carry out centralized procurement of drugs and medical consumables and supervises the implementation.
The centralized procurement platform is established in accordance with the unified planning and standards of the medical security administrative department of the State Council, and the provincial centralized procurement agency is responsible for management
.
Provincial centralized procurement agencies shall implement the transaction rules and standards formulated by the medical security administrative department, carry out the bidding, procurement, trading, and settlement of drugs and medical consumables, and monitor relevant information
.
Public medical institutions shall purchase necessary drugs and medical consumables from the provincial centralized procurement platform in accordance with regulations
.

　　The state encourages non-public medical institutions to participate in the centralized procurement of medicines and medical consumables
.

　　Medical institutions should make timely payments in accordance with the purchase and sale agreement, and encourage the medical security fund to settle directly with pharmaceutical companies
.

　　The medical security agency shall promptly announce to the public the list of medical institutions that have signed service agreements
.

　　Chapter V Public Management Services

　　The expenses required for the provision of public services for medical security shall be guaranteed by the finance at the same level in accordance with national regulations
.

　　The medical security administrative department shall supervise the conclusion and performance of service agreements
.

　　If the designated medical institution violates the service agreement, the medical security agency will deal with it in accordance with the service agreement, including interviews with relevant responsible personnel, suspension or non-appropriation of payment fees, recovery of violation fees, and requesting the designated medical institution to pay for breach of contract in accordance with the service agreement Suspend the medical services used by the relevant responsible personnel or the department involved in the medical security fund until the service agreement is terminated; the designated medical institution and its relevant responsible personnel have the right to make statements and defenses
.

　　If the medical security agency violates the service agreement, the designated medical agency has the right to request correction or request the medical security administrative department to coordinate processing and urge rectification, and may also apply for administrative reconsideration or file an administrative lawsuit according to law
.

　　Article 46 The State scientifically and rationally determines the payment standards and payment methods of the medical security fund, guides designated medical institutions to make reasonable diagnosis and treatment, promotes the orderly flow of patients, and improves the efficiency of the use of the medical security fund
.

　　The medical security agency shall promptly settle and allocate the medical security fund with the designated medical institution in accordance with the provisions of the service agreement
.

　　The medical security authorities at all levels should improve the direct settlement system for medical treatment in different places, and timely prepay and clear the settlement funds for medical treatment in different places, so as to facilitate the insured persons to enjoy medical protection treatment
.

　　Article 47 The State establishes a unified national medical security information system, promotes effective data sharing and utilization, implements real-time dynamic intelligent monitoring of big data, regulates data management and application permissions, and protects information and data security
.
The relevant information system of the designated medical institution shall be connected with the medical security information system
.

　　Article 48 The medical security administrative department shall promote the modernization of medical security public management services, actively introduce qualified social forces to participate in the service, and establish a medical insurance governance pattern of joint construction, governance and sharing
.
Standardize and strengthen cooperation with commercial insurance companies and social organizations, and improve incentive and restraint mechanisms
.

　　Chapter VI Supervision and Administration

　　The medical security administrative department has the right to take the following measures to implement supervision and inspection:

　　 (1) Consult, record, copy and supervise and inspect relevant materials;

　　 (2) Use information technology to carry out real-time monitoring and retrieve data from relevant information systems;

　　 (3) Seal up or seize materials that may be transferred, concealed, or lost, or that there is preliminary evidence to prove that they may be transferred, concealed, or lost;

　　 (4) Inquiring about units and individuals related to the investigation items, requesting them to explain the issues related to the investigation items and provide relevant supporting materials;

　　 (5) Hiring qualified accounting firms and other third-party institutions and professionals to assist in the inspection;

　　 (6) To stop the concealment, transfer, embezzlement, or misappropriation of the medical security fund and order it to be corrected;

　　 (7) Other measures that can be taken according to law
.

　　Article 54 Any organization or individual has the right to report and complain about violations of the medical security fund
.

　　Chapter VII Legal Liability

　　 (1) Failing to implement transaction rules and standards such as listing and withdrawal of the centralized procurement platform;

　　 (2) Abusing the power of centralized procurement, restricting market competition or causing unfair competition;

　　 (3) Seeking illegitimate benefits in the process of centralized procurement;

　　 (4) Other illegal acts in the centralized procurement process
.

　　 (1) Bidding at a price lower than the cost, or bidding through fraud, bid collusion, abuse of market dominance, etc.
;

　　 (2) Offering bribes to medical security agencies, centralized procurement agencies, designated medical institutions and their staff;

　　 (4) Other illegal acts in the bidding process
.

　　Article 67: State functionaries who abuse their powers, neglect their duties, or engage in malpractices for personal gains in medical security work shall be punished in accordance with the law
.

　　Article 68 Anyone who violates the provisions of this law and constitutes a crime shall be investigated for criminal responsibility in accordance with the law
.

　　Anyone who violates the provisions of this law and causes losses to relevant entities or individuals shall be liable for compensation in accordance with the law
.

　　Chapter VIII attached to the

　　Article 70 This law shall come into force on year, month and day
.

　　The "Medical Security Law" is imperative

　　Compliance upgrade of designated medical institutions

　　Article 61: If a designated medical institution has failed to establish an internal management system for the medical security fund, or fails to interface with the medical security information system in accordance with regulations, the medical security administrative department shall order corrections and may interview the relevant person in charge; refuse Those who make corrections shall be fined not less than 10,000 yuan but not more than 50,000 yuan; violations of other laws and administrative regulations shall be dealt with in accordance with the law by the relevant competent authorities
.

　　Article 63: Where designated medical institutions and their staff defraud medical security fund expenditures, the medical security administrative department shall order the refund and impose a fine of more than 2 times and less than 5 times the amount defrauded; order the designated medical institutions to suspend the relevant responsible departments for 6 months The above one year or less involves medical services used by the medical security fund until the service agreement is terminated by the medical security agency; if there is a qualification, the relevant competent authority shall revoke the qualification in accordance with the law
.

　　Article 64 If a designated medical institution violates the provisions of this law and causes major losses to the medical security fund or other serious adverse social impacts, the medical security administrative department shall deal with its legal representative or main person in charge to obtain income from the unit in the previous year A fine of more than 50% but not more than one time, and the management activities of designated medical institutions are prohibited within 5 years, and the relevant departments shall impose sanctions according to law
.

　　The industry generally believes that the "Medical Security Law" clearly responsibilities and empowers at the legislative level, that is, to clarify the people's medical security rights and standardize the operational procedures of medical security, including fund management, medical services, public management services, supervision and management, legal responsibilities, etc.
Strengthen the all-round supervision of the medical security system, especially the medical insurance fund
.

　　Severe punishment for violations

　　Comprehensively strengthen medical insurance supervision

　　Medical security is not only a major institutional arrangement related to the needs of people's livelihood security, but also a multi-level security system that involves complex relationships and is clearly different from other security systems
.
At this stage, the contradictions of imbalance and insufficiency of China's medical insurance still exist, and it is essential to improve the medical insurance fund supervision system and mechanism
.

　　With the "Medical Security Law" soliciting opinions, the supervision of the use of medical insurance funds, the reform of the medical insurance payment system and other policies have been "combined punches" one after another, which also reflects that China's medical insurance funds are still facing greater pressure
.
It is understood that the income of the employee medical insurance fund in 2020 is 1,573.
2 billion yuan, a decrease of 0.
7% over the previous year; on the other hand, the pressure on fund expenditures continues to increase.
Fund expenditures in 2020 are 1,286.
7 billion yuan, an increase of 1.
6% over the previous year
.

　　Industry analysis pointed out that strengthening the management of medical insurance funds, preventing illegal use of medical insurance funds, and further regulating the rational and legal use of medical insurance funds have become the core goals of reforming the medical insurance payment system and improving the governance of China's medical insurance
.

　　In 2020, the National Medical Insurance Administration will continue to strengthen the special management of combating fraudulent acquisition of medical security funds.
In the whole year, medical insurance departments at all levels inspected 627,000 designated medical institutions, investigated and dealt with 401,000 medical institutions that violated laws, regulations, and contracts.
Among them, 6,008 were dismissed from medical insurance agreements.
5457 companies were punished and transferred to 286 judicial organs.
A total of 26,100 people insured who violated laws and regulations were dealt with, of which 3,162 were suspended for settlement and 2062 were transferred to judicial organs.
A total of 22.
31 billion yuan was recovered in the whole year
.

　　Medical Security Law (Draft for Solicitation of Comments)

　　Head record

　　The first chapter always is

　　Chapter II Fundraising and Treatment

　　Chapter III Fund Management

　　Chapter IV Medical Services

　　Chapter V Public Management Services

　　Chapter VI Supervision and Administration

　　Chapter VII Legal Liability

　　Chapter VIII attached to the

　　The first chapter always is

Drugs Drugs Drugs medicine medicine medicine

　　Article 10 The State vigorously trains medical security talents and establishes a system for professional titles of medical security talents
.

　　Organizations and individuals that have made outstanding contributions to medical security will be commended and rewarded in accordance with national regulations
.

　　Chapter II Fundraising and Treatment

　　Section 1 Basic Medical Insurance

　　Article 12 Basic medical insurance includes basic medical insurance for employees and basic medical insurance for urban and rural residents
.

Enterprise business enterprise

　　Participants are not allowed to participate in the basic medical insurance repeatedly
.

　　The specific policies for the financing of basic medical insurance shall be formulated by the medical security administrative department of the State Council
.

　　Article 15 The payment scope of the basic medical insurance fund shall be organized and formulated by the medical security administrative department of the State Council
.

　　Article 16 The following medical expenses are not included in the payment scope of the basic medical insurance fund:

　　 (1) It should be paid from the work-related injury insurance fund;

　　 (2) Should be borne by a third person;

　　 (3) Should be borne by public health;

　　 (4) Seeking medical treatment abroad;

　　 (5) Sports fitness, health care consumption, and health check-ups;

　　 (6) Other expenses not paid by the basic medical insurance fund prescribed by the state
.

　　When encountering a major impact on economic and social development, the scope of non-payment of the basic medical insurance fund can be adjusted temporarily after legal procedures
.

　　The maternity medical expenses incurred by women who have not participated in maternity insurance shall be resolved by participating in basic medical insurance
.

　　Section 2 Multi-level medical insurance

　　Chapter III Fund Management

　　The basic medical insurance fund shall be deposited in a special fiscal account
.

　　Article 26 The medical security fund is earmarked for use only, and no organization or individual may embezzle or misappropriate it
.

　　Article 27 The medical security fund shall strengthen budget management and implement the budget and final accounts system
.

　　Article 29 On the premise of ensuring safety, the medical security fund shall maintain and increase its value by investing and operating in accordance with the regulations of the State Council
.

　　Article 30 The medical security agency shall regularly announce the income, expenditure, and balance of the medical security fund to the public, and accept social supervision
.

　　Chapter IV Medical Services

Tender Tender Tender

　　The state encourages non-public medical institutions to participate in the centralized procurement of medicines and medical consumables
.

　　、、，，，、、
。、、，，、
。

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。

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。
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。

　　、，，，、、
。

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。

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。

　　（），、、、、，
。

　　The medical security agency shall promptly announce to the public the list of medical institutions that have signed service agreements
.

　　Chapter V Public Management Services

　　The expenses required for the provision of public services for medical security shall be guaranteed by the finance at the same level in accordance with national regulations
.

　　The medical security administrative department shall supervise the conclusion and performance of service agreements
.

　　The medical security agency shall promptly settle and allocate the medical security fund with the designated medical institution in accordance with the provisions of the service agreement
.

　　，、，，，
。
。

　　，，
。、，
。

　　、、，，
。

　　、
。

　　，，
。、、，
。

　　，，、
。

　　The medical security administrative department has the right to take the following measures to implement supervision and inspection:

　　 (1) Consult, record, copy and supervise and inspect relevant materials;

　　 (2) Use information technology to carry out real-time monitoring and retrieve data from relevant information systems;

　　 (3) Seal up or seize materials that may be transferred, concealed, or lost, or that there is preliminary evidence to prove that they may be transferred, concealed, or lost;

　　 (4) Inquiring about units and individuals related to the investigation items, requesting them to explain the issues related to the investigation items and provide relevant supporting materials;

　　 (5) Hiring qualified accounting firms and other third-party institutions and professionals to assist in the inspection;

　　 (6) To stop the concealment, transfer, embezzlement, or misappropriation of the medical security fund and order it to be corrected;

　　 (7) Other measures that can be taken according to law
.

　　Article 54 Any organization or individual has the right to report and complain about violations of the medical security fund
.

　　Chapter VII Legal Liability

　　 (1) Failing to implement transaction rules and standards such as listing and withdrawal of the centralized procurement platform;

　　 (2) Abusing the power of centralized procurement, restricting market competition or causing unfair competition;

　　 (3) Seeking illegitimate benefits in the process of centralized procurement;

　　 (4) Other illegal acts in the centralized procurement process
.

　　 (1) Bidding at a price lower than the cost, or bidding through fraud, bid collusion, abuse of market dominance, etc.
;

　　 (2) Offering bribes to medical security agencies, centralized procurement agencies, designated medical institutions and their staff;

　　 (4) Other illegal acts in the bidding process
.

　　Article 67: State functionaries who abuse their powers, neglect their duties, or engage in malpractices for personal gains in medical security work shall be punished in accordance with the law
.

　　Article 68 Anyone who violates the provisions of this law and constitutes a crime shall be investigated for criminal responsibility in accordance with the law
.

　　Anyone who violates the provisions of this law and causes losses to relevant entities or individuals shall be liable for compensation in accordance with the law
.

　　Chapter VIII attached to the

　　Article 70 This law shall come into force on year, month and day
.

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