Points!Jiangxi Traditional Chinese Medicine Medical Insurance Policy has been adjusted ...

In order to thoroughly implement the overall requirements of the 15th Provincial Party Congress decision -making and deployment and the provincial party committee and provincial government on the high -quality development of Chinese medicine, we solidly promote the comprehensive construction of happiness in Jiangxi, and fully support the construction of the comprehensive reform demonstration zone of the national Chinese medicine in our province. Help build a leading domestic and world -renowned province, promote the innovation and development of traditional Chinese medicine inheritance in our province, better meet the needs of the people of traditional Chinese medicine, and protect the health of the people. Recently, the General Office of the People's Government of Jiangxi Province forwarded the Provincial Medical Insurance Bureau The "Opinions on the Implementation of Medical Insurance Supporting the Innovation and Development of TCM inheritance", and 20 specific measures for 6 aspects.

Incorporate eligible Chinese medicine and medicine institutions into the scope of management of fixed -point medical insurance

Primary medical and health institutions, rehabilitation hospitals, Anning therapy centers, nursing homes, and pension institutions that provide Chinese medicine services will be included in the management of fixed -point management.

In a timely manner, the qualified designated Chinese medicine medical institutions will be included in the direct settlement scope of the medical direct settlement in accordance with regulations.

After conducting a designated Chinese medicine medical institution for Internet diagnosis and treatment, after signing a supplementary agreement with regional medical insurance agencies in accordance with regulations, the "Internet+" Chinese medicine services provided by it are included in the scope of medical insurance payment.

Increase suitable Chinese medicine and traditional Chinese medicine medical service projects in the scope of medical insurance payment

Support the province's pharmaceutical manufacturers to report independent research and development, strong innovation, and high clinical value, and apply to the State Medical Insurance Bureau into the scope of the medical insurance and drug directory adjustment scope to adjust to the National Medical Insurance Bureau in accordance with regulations.

Focusing on supporting the "Gan -flavored" authentic drinks such as the camphor tree gang and Jianchang Gang of our province, the Jianchang Gang and other traditional "Gan -flavored" films are incorporated into the scope of the province's medical insurance payment in accordance with the procedures.

The support of the Chinese medicine preparations is approved by the country or our province's pharmaceutical supervision and management department to be transferred to the scope of medical insurance payment in accordance with regulations.

Priority support the traditional Chinese medicine medical service projects such as thermistor and other traditional Chinese medicine medical services and the new Chinese medicine medical service projects such as the advantages of traditional Chinese medicine and the advantages of traditional Chinese medicine, and include the scope of basic medical insurance payment in accordance with the procedures.

Improve the price management policy of traditional Chinese medicine and traditional Chinese medicine medical service projects

Public medical institutions purchased Chinese medicine films from regular channels, and sold in strict accordance with the actual purchase price of not more than 25%. Non -drinking Chinese medicines are sold in strict accordance with the actual purchase price.

For traditional Chinese medicine technologies that originated from ancient classics, are still widely used, and have accurate curative effects, and have outstanding innovative and economic advantages, simplify the new price project audit procedures, and open up green channels.

Prioritize the income of traditional Chinese medicine medical service projects with obvious functional curative effect, wide acceptance of patients, outstanding characteristics, high -quality advantages, reflecting labor value, long history of application, and obvious costs and prices.

Improve the treatment policy suitable for traditional Chinese medicine

The traditional Chinese medicine and traditional Chinese medicine diagnosis and treatment service projects that meet the prescribed regulations are included in the scope of the outpatient clinic. The insured people receive traditional Chinese medicine treatment in the outpatient clinic of TCM medical institutions, and enjoy the overall treatment of the outpatient clinic in accordance with regulations.

For regions that have been paid by the diseased diagnosis of disease diagnosis (DRG) and are paid according to the type of disease, the coefficients and points of traditional Chinese medicine medical institutions and traditional Chinese medicine diseases are appropriately improved, and the characteristics and advantages of traditional Chinese medicine services are fully reflected. For rehabilitation medical care, tranquility treatment, etc., which requires long -term hospitalization, Chinese medicine superior diseases can be paid according to bed.

During the epidemic, the traditional Chinese medicine diagnosis and treatment projects, Chinese medicine, Chinese medicine tablets, and traditional Chinese medicine prescriptions in the national health and health department diagnosis and treatment plan are not within the scope of the medical insurance directory, and they can be temporarily included in the scope of medical insurance payment in our province.

Encourage designated Chinese medicine medical institutions to take the diagnosis and treatment of slow special diseases of medical insurance clinics within its diagnosis and treatment, and give full play to the role of traditional Chinese medicine in the prevention and treatment of slow special diseases. Pay in the first -level medical and health institutions in the qualified primary medical and health institutions.

Support the construction of a close medical consortium led by the construction of traditional Chinese medicine medical institutions, implement payment policies of total payment, strengthen supervision and assessment, residual reserves, and reasonable overcome sharing, promote high -quality traditional Chinese medicine medical resources to sink to grass -roots medical and health institutions, and improve grassroots Chinese medicine medicine Service capabilities.

Attached::

The General Office of the Jiangxi Provincial People's Government forwarded the Provincial Medical Insurance Bureau

Notice on the implementation opinions of medical insurance support inheritance and innovation and development of traditional Chinese medicine

Municipal, county (district) people's governments, provincial government departments:

The Provincial Medical Insurance Bureau ’s“ Implementation Opinions on the Innovation and Innovation and Development of Medical Insurance Supporting TCM inheritance ”has agreed to the provincial government. It is now reposted to you. Please carefully implement it.

August 2, 2022

(This piece is proactive)

Implementation opinions on medical insurance support for traditional Chinese medicine inheritance and innovation development

Provincial Medical Insurance Bureau

In order to conscientiously implement the "Opinions of the Central Committee of the Communist Party of China on Promoting the Innovation and Development of TCM inheritance and Innovation", "Opinions of the Central Committee of the Communist Party of China on Deepening the Reform of the Medical Security System", "National Medical Security Bureau State Traditional Chinese Medicine Administration on medical insurance support Chinese medicine inheritance and innovation development The spirit of the guidance "document, in -depth implementation of the overall requirements of the 15th Provincial Party Congress decision -making and deployment and the provincial party committee and provincial government on the high -quality development of Chinese medicine, solidly promote the comprehensive construction of happiness in Jiangxi, and fully support the comprehensive comprehensive Chinese traditional Chinese medicine in our province. The construction of the reform demonstration zone helps to build a leading and world -renowned Chinese medicine province, promote the innovation and development of traditional Chinese medicine in our province, better meet the needs of traditional Chinese medicine services in the people, protect the health of participating people, and formulate this implementation opinion.

1. Incorporate eligible Chinese medicine and medicine institutions into the scope of management scope of fixed -point management

(1) Timely, the qualified Chinese medicine (including Chinese and Western medicine, the same below) medical institutions, Chinese medicine retail pharmacies, etc. are included in the management of fixed -point management in accordance with regulations. In accordance with regulations, grass -roots medical and health institutions, rehabilitation hospitals, Anning therapy centers, nursing homes, and pension institutions are included in the management of medical security institutions in accordance with the requirements. (2) Timely the eligible designated Chinese medicine medical institutions will be incorporated into the targeted scope of direct settlement in accordance with the regulations to improve the radiation of the regional area of ​​traditional Chinese medicine medical institutions.

(3) Designated TCM medical institutions to carry out Internet diagnosis and treatment, after signing supplementary agreements with regional medical insurance agencies in accordance with regulations, incorporate the "Internet+" traditional Chinese medicine services provided in the scope of medical insurance payment.

2. Incorporate suitable Chinese medicine and traditional Chinese medicine medical service projects into the scope of medical insurance payment

(4) Support the use of Chinese medicine. The new Chinese patent medicines will be adjusted in the national medical insurance catalog in time into the scope of medical insurance payment in our province. Support Chinese medicine management scope of the province's "dual -channel" drug management with high clinical value in medical insurance negotiating drugs, urgent need, and lack of alternative replacement. We will conscientiously implement the pilot policy of the national medical insurance payment standards, and the support of medical insurance payment standards tilted to the Chinese patent medicine within the pilot scope. Support the province's pharmaceutical manufacturers to report independent research and development, strong innovation, and high clinical value, and apply to the State Medical Insurance Bureau into the scope of the medical insurance and drug directory adjustment scope to adjust to the National Medical Insurance Bureau in accordance with regulations.

(5) Support the use of Chinese medicine drinks. According to the burden of the medical insurance fund and the needs of the people participating in the insurance, establish and improve the management and dynamic adjustment mechanism of medical insurance and drinking tablets, adhere to expert review, give priority to clinical necessity, safety and effectiveness, reasonable price, being able to ensure supply and in accordance with national drug standards or our province Traditional Chinese medicine drinking tablets that standardize Chinese medicine films are included in the payment scope of the province's medical insurance fund in accordance with the procedures. Support will be derived from the raw (fresh), 煅, fried (bran fried, coke, burning), hot (燀), wine, salt, ginger, vinegar, and honey of the same Chinese medicine tablet, After the National Medical Insurance Administration is filed, it is included in the scope of medical insurance payment in our province. Focusing on supporting the "Gan -flavored" authentic drinks such as the camphor tree gang and Jianchang Gang of our province, the Jianchang Gang and other traditional "Gan -flavored" films are incorporated into the scope of the province's medical insurance payment in accordance with the procedures. For some Chinese medicines that can be used to treat special diseases such as tumors, fetal movements and infertility, it can organize expert reviews to treat special diseases such as tumors, fetal movement and infertility, Scope of medical insurance payment. For Chinese medicine formulas that have been included in the scope of medical insurance payment in our province, the Chinese medicine formula particles of the same name are filed by the provincial pharmaceutical supervision and management department and purchased on the provincial provincial pharmaceutical procurement platform. The provincial medical institution is used, and the medical insurance is paid by class B. The prescription of traditional Chinese medicines paid by medical insurance, in principle, controls within 20 flavors, and strictly grasp the use of precious medicinal materials; the treatment prescriptions for special diseases such as malignant tumors can be appropriately relaxed to 25 flavors. Explore "dual channels" management for some Chinese medicine films that are quality, safe and reliable and full of market competition.

(6) Support the use of traditional Chinese medicine preparations. According to the burden of the medical insurance fund and the needs of the people participating in the insurance, establish and improve the management and dynamic adjustment mechanism of the medical insurance medical institutions, adhere to the expert review of experts, and timely according to the procedures, the clinical necessity, safety and effective price, reasonable price, capable of supply and provincial drug supervision can be used in accordance with the procedures. The preparations approved by the management department approved or filed are included in the payment scope of the province's medical insurance fund, and the medical insurance is paid according to the category B in this designated medical institution. Focusing on supporting medical institutions relying on traditional classic famous prescriptions, the efficacy and outstanding advantages of traditional Chinese medicine preparations are incorporated into the scope of medical insurance payment in our province. For some traditional Chinese medicine preparations that have high clinical value, exact effects, high prices, or high -impact on medical insurance funds, they can organize expert review and negotiate with medical institutions to form a medical insurance payment standard recognized by both parties and include the scope of medical insurance payment in our province. The support of the Chinese medicine preparations is approved by the country or our province's pharmaceutical supervision and management department to be transferred to the scope of medical insurance payment in accordance with regulations.

(7) Support the application of traditional Chinese medicine medical service projects. On the basis of determining the clinical path and recommendation of the advantages of traditional Chinese medicine, according to the ability of the medical insurance fund, priority supports the effective efficacy of thermal moxibustion and the advantages of traditional Chinese medicine, and the new technologies and other new technologies and other new technologies. The additional Chinese medicine medical service items are included in the scope of basic medical insurance payment according to procedures.

3. Improve the price management policy of traditional Chinese medicine and traditional Chinese medicine medical service projects

(8) Public medical institutions purchase Chinese medicine films from regular channels, and they are sold in strict accordance with the actual purchase price of no more than 25%. Non -drinking Chinese medicines are sold in strict accordance with the actual purchase price. The specific range of Chinese medicine drinks is subject to the qualitative of the pharmaceutical regulatory department. If a public medical institution cannot provide the actual purchase bills of traditional Chinese medicine, it can refer to the purchase price of social pharmacies in the region as the basis for regulatory. Chinese medicine drinks and prepared traditional Chinese medicine preparations used by medical institutions are self -pricing. The Chinese medicine formula particles purchased by public medical institutions are encouraged to promote the transaction of transactions through the provincial -level pharmaceutical centralized procurement platform to promote the transaction.

(9) Establish a target -oriented Chinese medicine service price project management mechanism to optimize existing Chinese medicine price projects. Normal acceptance of the application for new Chinese medicine service projects to enrich the price project of traditional Chinese medicine. For traditional Chinese medicine technologies that originated from ancient classics, are still widely used, and have accurate curative effects, and have outstanding innovative and economic advantages, simplify the new price project audit procedures, and open up green channels. (10) Establish a sound and sensitive price dynamic adjustment mechanism, carry out price adjustment assessment in a timely manner, and focus on the traditional Chinese medicine medical service projects in the dynamic adjustment of medical services, give priority to obvious functional effects, widely accept patients, outstanding characteristics, reflect the value of labor service value The application of traditional Chinese medicine medical service projects with a long history and obvious deviation of costs and prices is included in the scope of price adjustment.

4. Improve the treatment policy suitable for traditional Chinese medicine

(11) Traditional Chinese medicine is included in the outpatient clinic. The traditional Chinese medicine and traditional Chinese medicine diagnosis and treatment service projects that meet the prescribed regulations are included in the scope of the outpatient clinic. The insured people receive traditional Chinese medicine treatment in the outpatient clinic of TCM medical institutions, and enjoy the overall treatment of the outpatient clinic in accordance with regulations.

(12) Improve medical insurance payment methods suitable for traditional Chinese medicine. Explore the implementation of traditional Chinese medicine diseases to pay according to the type of disease. Prioritize the number of traditional Chinese medicine diseases released by the country into the scope of the disease. For regions that have been paid by the diseased diagnosis of disease diagnosis (DRG) and are paid according to the type of disease, the coefficients and points of traditional Chinese medicine medical institutions and traditional Chinese medicine diseases are appropriately improved, and the characteristics and advantages of traditional Chinese medicine services are fully reflected. For rehabilitation medical care, tranquility treatment, etc., which requires long -term hospitalization, Chinese medicine superior diseases can be paid according to bed. Explore traditional Chinese medicine diseases that have long treatment cycles, controllable risks, and continuous treatment, carry out daily medical services, implement payment according to the disease, reasonably determine the payment standards, and implement the national unified day ward disease catalog in accordance with regulations.

(13) Pay attention to the positive role of traditional Chinese medicine in the treatment of major epidemic medical treatment. During the epidemic, the traditional Chinese medicine diagnosis and treatment projects, Chinese medicine, Chinese medicine tablets, and traditional Chinese medicine prescriptions in the national health and health department diagnosis and treatment plan are not within the scope of the medical insurance directory, and they can be temporarily included in the scope of medical insurance payment in our province.

(14) Support grass -roots medical institutions to provide Chinese medicine services. Encourage designated Chinese medicine medical institutions to take the diagnosis and treatment of slow special diseases of medical insurance clinics within its diagnosis and treatment, and give full play to the role of traditional Chinese medicine in the prevention and treatment of slow special diseases. Pay in the first -level medical and health institutions in the qualified primary medical and health institutions. The medical insurance department strengthens the management, improves settlement methods, strengthens performance evaluation, improves the incentive policies of residual retention, and encourages the guidance of grass -roots medical and health institutions to provide appropriate Chinese medicine services.

(15) Support the construction of a close medical consortium for the establishment of a traditional Chinese medicine medical institution, implement the payment policy of total payment, strengthen supervision and assessment, balance reservation, and reasonable overcome sharing, and promote high -quality traditional Chinese medicine medical resources to sink to grassroots medical and health institutions. Improve the ability of grassroots Chinese medicine services.

Fifth, improve the use of medical insurance funds of Chinese medicine institutions

(16) Strengthen the budget management of total medical insurance, and improve the scientific and rationality of the total budget of medical insurance. It can increase the weight of the total budget management Chinese medicine medical institutions, and focus on tilting traditional Chinese medicine medical institutions based on traditional Chinese medicine diagnosis and treatment income. Improve the assessment and evaluation system that is compatible with the total budget management of the medical insurance fund, and promote the strengthening of self -management, improving clinical efficacy, reducing service costs, and improving service quality.

(17) Strengthen daily supervision and management. We will improve the normalized daily regulatory mechanism, strengthen the management of expenditures for fixed -point Chinese medicine medical institutions, Chinese medicine retail pharmacy medical insurance funds, and prevent medical insurance funds such as fraudulent medical insurance funds such as medical insurance, hospitalization, drug purchase, and virtual diagnosis and treatment projects. Make full use of medical insurance intelligent monitoring and on -site inspection and other means to strengthen the supervision and inspection of designated Chinese medicine institutions, promote the implementation of the main body responsibility for the implementation of the fund use of fixed -point Chinese medicine institutions, rationally use medical insurance funds, and standardize the behavior of traditional Chinese medicine diagnosis and treatment.

(18) Improve the comprehensive regulatory mechanism. Adapt to the characteristics of traditional Chinese medicine service management, and establish and improve the comprehensive supervision system of mutual cooperation and coordinated supervision of medical insurance departments and traditional Chinese medicine authorities. Strengthen information sharing and interconnection, promote the coordinated use of supervision results, improve the departmental linkage mechanism, carry out joint inspections, form a joint supervision force, strengthen the effective connection between the administrative law enforcement of fund supervision and criminal justice, and severely investigate and deal with various designated Chinese medicine institutions in accordance with the law. Essence

6. Increase publicity of medical insurance policies

(19) Public medical insurance policy information to the society in a timely manner. By setting up the "reception day" of an enterprise, the "medical insurance and pharmaceutical company face -to -face" policy preaching and consultation meeting were held to publicize the medical insurance policy to the province's Chinese medicine enterprises to answer questions for enterprises.

(20) Organize designated medical institutions in a timely manner to carry out publicity and training, and to promote and interpret medical insurance policies to propagate and interpret medical insurance policies to designated targeted medical institutions and designated medical institutions in traditional Chinese medicine in our province.

This opinion is implemented from the date of issuance. The relevant regulations in the province are inconsistent with this opinion, and it is implemented according to this opinion. If the state has corresponding policy adjustments, it is implemented in accordance with the new national adjustment policy. The policy content involved in this opinion is explained by the Provincial Medical Insurance Bureau.

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