Source: The National Medical Insurance Administration

Recently, the National Medical Insurance Bureau issued the "Notice on the Management of basic medical insurance medical consumables payment" (hereinafter referred to as the notice), which clearly requires all localities to solidly promote the application of national medical insurance medical consumables code, timely update the classification and code database of medical consumables formulated by the National Medical Insurance Bureau, and improve the accuracy and standardization of the application of medical consumables code. Achieve medical consumables with code procurement, code use, code settlement, code supervision, to ensure the national unity of medical consumables classification and code.

For the scope of consumables included in medical insurance payment, the Notice pointed out that it is necessary to adapt to the principle of "separation of technical labor and material consumption" in the price reform of medical services, strengthen the linkage of medical service price items and medical consumables payment management, and gradually incorporate disposable medical consumables that are not included in the price composition of medical service items into the scope of medical insurance payment management.

In terms of medical insurance access, the "Notice" stipulates that the functional positioning of "ensuring the basic" is adhered to. The access and management of medical consumables for basic medical insurance should always firmly adhere to the functional positioning of "ensuring the basic", try our best and do what we can, reasonably determine the payment scope and payment standard, pay attention to the strategic purchase role of the medical insurance fund, and bring clinically necessary, safe and effective medical consumables with reasonable prices into the medical insurance payment scope according to procedures.

In principle, medical consumables with low clinical value, prices or costs far beyond the fund and the patient's affordability, and non-therapeutic rehabilitation equipment shall not be included in the scope of medical insurance payment. For consumables expressly required by the state not to be included in the scope of medical insurance payment, adhere to the original provisions.

At the same time, the "Notice" clearly, the National Medical Insurance Bureau will study the establishment of medical insurance medical consumables general name management system, based on medical insurance medical consumables classification and code database, determine the naming specification appropriate for medical insurance payment management, gradually develop different categories of medical consumables general name naming rules, preparation of medical insurance general name, as the basis for the next step of medical insurance payment management.

For medical consumables that have developed common names, we should actively promote the medical insurance payment management of medical consumables by common names. For medical consumables that have not yet developed a common name, the medical insurance payment management is temporarily carried out according to the current classification and code.

It is worth noting that the "Notice" also proposed to establish a dynamic adjustment mechanism to explore exclusive consumables negotiation access, according to the "Notice", provinces should organize medical consumables, clinical, medical insurance management, technical evaluation and other experts and industry related associations, through the standardized review process, the qualified medical consumables will be included in the catalogue according to the procedure, and the review results are disclosed to the society in a timely manner. Priority is encouraged for the inclusion of selected consumables in the catalogue that are subject to the current payment policy. Explore access to exclusive or high-value products through negotiation and other means.

In addition, we should establish a sound dynamic adjustment mechanism. Comprehensive consideration of the technical progress of medical consumables, clinical use, price and cost level, medical insurance fund and the affordability of the insured and other factors, to achieve dynamic adjustment of entry and exit. Timely addition of necessary new technology products, exit clinical can be better replaced, poor economic evaluation, by the relevant departments included in the negative list and other products that do not meet the requirements of medical insurance.

Full text of Notice on the payment management of medical consumables for basic medical insurance