"19 Jiangsu Medical Insurance Articles" promotes inheritance and innovation of Chinese medicine

On June 13, the reporter was informed that the Jiangsu Provincial Medical Security Bureau and the Provincial Administration of Traditional Chinese Medicine recently issued the "Implementation Opinions on the Innovation and Development of Medical Insurance Supporting the Innovation of TCM" (hereinafter referred to as the "Implementation Opinions"). Further promote the innovation and development of Jiangsu TCM inheritance.

Support for the management of designated medical insurance, incorporate qualified designated Chinese medicine medical institutions into the scope of direct settlement of medical treatment in different places, and rely on the "Internet+" Chinese medicine services provided by Internet hospitals provided by traditional Chinese medicine medical institutions to be included in the payment scope of the medical insurance fund.

Support for the payment of medical insurance funds, incorporate more traditional Chinese medicine medical service projects and traditional Chinese medicines into the medical insurance directory, and the qualified Chinese medicine drinks (Chinese medicine formula particles) and the traditional Chinese medicine preparations prepared by medical institutions are included in the province's medical insurance directory according to the procedures, and the advantageous diseases are used for Chinese medicine. Pay for a single disease.

Support the price management of pharmaceutical services, adjust the price of traditional Chinese medicine medical services in batches and classified, and rationally open the difference in technical level. Chinese medicine drinks and Chinese medicine preparations used by medical institutions to implement autonomous pricing.

It is supported by the prevention and control of major epidemic conditions. It will cope with Chinese medicine, traditional Chinese medicine, Chinese medicine diagnosis and treatment projects, and special prescriptions approved or filed by the provincial and our province in accordance with the country and our province. The regulations are temporarily included in the scope of payment of the medical insurance fund.

If the medical insurance fund is supported by the supervision of the medical insurance fund, if the public medical institution cannot provide the actual procurement bills of Chinese medicine, it can refer to the purchase price of social pharmacies in the region as the basis for regulatory.

There are six aspects of "Implementation Opinions" and 19 specific measures.

1. Timely incorporating qualified Chinese medicine (including combination of traditional Chinese and western medicine, minority doctors, the same below) medical institutions, Chinese medicine retail pharmacies, etc. are included in medical security design.

2. Timely, the primary medical and health institutions, rehabilitation hospitals, Anning therapy centers, nursing homes, and pension institutions that provide qualified Chinese medicine services are included in the management of medical security institutions.

3. Incorporate qualified fixed -point TCM medical institutions into the scope of direct settlement of medical treatment in different places.

4. Relying on the "Internet+" traditional Chinese medicine services provided by the Internet hospital opened by traditional Chinese medicine medical institutions into the scope of the medical insurance fund payment.

5. According to clinical needs and fund guarantee capabilities, the clinical use of wide clinical use, obvious functional effects, and outstanding advantages are included in the scope of medical insurance payment.

6. Improve the medical insurance payment policy of traditional Chinese medicine diagnosis and treatment projects, and steadily and orderly adjust the category of medical insurance payment categories that have the characteristics of traditional Chinese medicine and reflect the value of traditional Chinese medicine.

7. Establish a dynamic adjustment mechanism for hospital preparations and traditional Chinese medicine decoction tablets that are connected to the national drug catalog. It will meet the national medicines that meet the clinical needs, reasonable price, and accurate efficacy. The Chinese medicine preparations prepared by the institution are included in the medical insurance directory in our province according to the procedure.

8. Incorporate Chinese medicine in the "National Talking Medicine" into the "dual channel" management, and the patient's medication channels are expanded to fixed -point retail pharmacies to better guarantee the needs of the people in the insurance.

9. In a major epidemic, the Chinese medicine, traditional Chinese medicine decoction tablets, traditional Chinese medicine diagnosis and treatment projects, and special prescriptions approved by the provincial and our province will be temporarily incorporated into medical insurance Fund payment scope.

10. To implement DRG paid areas, we must improve the coding system such as the classification of traditional Chinese medicine diseases connected with disease classification, and actively explore the application of the traditional Chinese medicine characteristic disease group in the reform of the DRG payment method.

11. Implement DIP paid areas, actively promote the implementation of the Chinese medicine superior diseases, pay according to the type of disease, appropriately increase the disease score, and implement dynamic adjustment.

12. Selected the characteristics of traditional Chinese medicine with obvious characteristics, clear treatment paths, and stable costs in batches, formulate clinical paths, reasonably determine payment standards, implement single -disease payment, and encourage the same price of traditional Chinese and western medicine.

13. For rehabilitation medical care, tranquility treatment, etc., the types of Chinese medicine that requires long -term hospitalization and treatment can be paid on the bed daily.

14. Gradually improve the connotation of a family doctor's contract service package, and incorporate the appropriate Chinese medicine service projects that are appropriate to the grass -roots medical institutions into family doctors' contract content to achieve a unified code.

15. Support fixed -point traditional Chinese medicine medical institutions to carry out "Internet+" Chinese medicine services in accordance with regulations to achieve equivalent payment policies for online and offline medical services. Open the mobile payment function of the medical insurance to realize the online payment of the "Internet+" Chinese medicine service fee for the insured person.

16. Improve the dynamic adjustment mechanism of medical services, adjust the prices of traditional Chinese medicine medical services in batches, classified, and classified the price of traditional Chinese medicine medical services, prioritize the technical level, high inheritance value, accurate efficacy, and obvious advantages of traditional Chinese medicine service projects, and reasonably open the technical level difference.

17. Medical institutions implement the current state of traditional Chinese medicine decoction additional policy. Chinese medicine drinks and configuration Chinese medicine preparations used by medical institutions are self -pricing.

18. Use the unified intelligent monitoring of medical insurance and on -site inspections in the province to strengthen the supervision and inspection of designated Chinese medicine institutions to prevent the occurrence of medical insurance funds in the medical insurance fund for false medical treatment, hospitalization, drug purchase, and virtual diagnosis and treatment projects.

19. Strengthen coordination between departments, and establish a comprehensive system that cooperates and coordinate supervision between medical insurance, public security, traditional Chinese medicine, and market supervision departments.We will vigorously promote strong measures such as the connection of torture and the supervision of the Discipline Inspection Commission, and severely investigate and deal with various designated Chinese medicine institutions in accordance with the law.(Reporter Sun Haiyan)

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