Medical Insurance Bureau and Administration of Traditional Chinese Medicine： Incorporate qualified Chinese herbal pieces, Chinese patent medicines, and Chinese medicinal preparations from medical inst

　　According to the news from official website, state administration of traditional chinese medicine, recently, the Office of the National Health Insurance Bureau and the Office of state administration of traditional chinese medicine jointly issued the Guiding Opinions on Medical Insurance Supporting the Inheritance, Innovation and Development of Traditional Chinese Medicine, which clearly stated that qualified Chinese herbal pieces, proprietary Chinese medicines and traditional Chinese medicine preparations in medical institutions should be included in the medical insurance drug list according to regulations. The preparation and use of Chinese patent medicines that have been negotiated by the state into the medical insurance catalogue will be included in the monitoring and evaluation. Make full use of the "dual-channel" drug management mechanism, expand the channels of drug use for insured patients to designated retail pharmacies, and better protect the drug demand of insured people. All localities should, according to the fund’s affordability and clinical needs, bring eligible ethnic medicines, Chinese medicine preparations and Chinese medicine pieces from medical institutions into the scope of local medical insurance payment according to procedures, and establish a dynamic adjustment mechanism. Will conform to the "prescription management measures" and "hospital Chinese herbal pieces management norms" but beyond the "People’s Republic of China (PRC) Pharmacopoeia" provisions of the commonly used dose of Chinese herbal pieces into the scope of medical insurance payment.

　　Attached to the original:

　　In order to implement the "Opinions of the Central Committee of the Communist Party of China and the State Council on Promoting the Inheritance, Innovation and Development of Chinese Medicine" and "Some Policies and Measures of the General Office of the State Council on Accelerating the Development of Chinese Medicine Characteristics" and other documents, give full play to the advantages of the medical security system, support the inheritance and innovation of Chinese medicine, and better meet the people’s demand for Chinese medicine services, we hereby put forward the following opinions.

　　First, fully understand the significance of medical insurance to support the inheritance, innovation and development of traditional Chinese medicine.

　　Medical security is an important institutional arrangement to reduce the burden of medical treatment for the masses, improve people’s livelihood and well-being, and maintain social harmony and stability. It has played an active role in regulating the rational allocation of medical resources and promoting medical reform. Giving full play to the function of medical insurance and further improving the medical insurance support policy of traditional Chinese medicine is an important decision-making arrangement of the CPC Central Committee and the State Council, and an inevitable requirement to meet the growing medical and health needs of the people. Inheriting, innovating and developing Chinese medicine is an important part of Socialism with Chinese characteristics’s cause in the new era, a great event for the rejuvenation of the Chinese nation, and an inevitable requirement for building a healthy development model with China characteristics in which Chinese medicine and western medicine complement each other and develop harmoniously. Traditional Chinese Medicine (TCM) has played an important role in fighting the COVID-19 epidemic with its unique advantages and functions. Medical insurance supporting the inheritance, innovation and development of traditional Chinese medicine is a concrete measure to implement the important exposition of the Supreme Leader General Secretary on the work of traditional Chinese medicine and to inherit, develop and make good use of traditional Chinese medicine. Medical insurance departments at all levels and departments in charge of traditional Chinese medicine should effectively improve their political stance, unify their thoughts and actions with the decision-making and deployment of the CPC Central Committee and the State Council, firmly establish the development ideology centered on people’s health, deepen the reform of medical security system with greater strength and determination, and support and promote the inheritance, innovation and development of traditional Chinese medicine.

　　Two, will meet the conditions of Chinese medicine institutions into the designated medical insurance.

　　(a) in a timely manner to meet the conditions of Chinese medicine (including integrated traditional Chinese and Western medicine, minority medicine, the same below) medical institutions, Chinese medicine retail pharmacies and other medical insurance designated agreement management. In accordance with the provisions, the basic medical and health institutions and rehabilitation hospitals, hospice care centers, nursing homes and old-age care institutions that meet the requirements for providing Chinese medicine services will be included in the designated management of medical insurance.

　　(two) in a timely manner to meet the conditions of the designated medical institutions of traditional Chinese medicine into the designated scope of direct settlement of medical treatment in different places, to enhance the regional radiation of traditional Chinese medicine medical institutions.

　　(three) the designated Chinese medicine medical institutions that carry out Internet diagnosis and treatment shall, after signing a supplementary agreement with the medical insurance agencies in the overall planning area, include the "internet plus" Chinese medicine services provided by them into the scope of medical insurance payment.

　　Three, strengthen the management of Chinese medicine service price

　　(4) Establish a goal-oriented management mechanism for TCM service price items, optimize existing TCM service price items, improve the management policies for new TCM service price items, and enrich TCM service price items. For traditional Chinese medicine technologies that are derived from ancient classics and are still widely used and have definite curative effects, as well as new Chinese medicine technologies with outstanding innovative and economic advantages, the review procedures for new price items will be simplified and a green channel will be opened up.

　　(5) Establish and improve a sensitive and moderate price dynamic adjustment mechanism, carry out price adjustment evaluation in a timely manner, give priority to Chinese medicine medical service items in the dynamic adjustment of medical service prices, and give priority to Chinese medicine medical service items with obvious functional efficacy, wide acceptance by patients, outstanding characteristic advantages, reflecting labor value, long application history and obvious deviation in cost and price.

　　(six) public medical institutions from the formal channels to purchase Chinese herbal pieces, in strict accordance with the actual purchase price plus no more than 25% sales. Non-decoction pieces of Chinese medicine are sold in strict accordance with the actual purchase price "zero difference rate". The specific scope of Chinese herbal pieces shall be subject to the qualitative determination of the drug regulatory authorities. Public medical institutions can not provide the actual purchase bills of Chinese herbal pieces, and can refer to the purchase price of social pharmacies in the region as the regulatory basis. Chinese herbal pieces processed and used by medical institutions and prepared Chinese herbal preparations are subject to independent pricing. Encourage the traditional Chinese medicine formula granules purchased by public medical institutions to be included in the online trading of provincial centralized pharmaceutical procurement platforms, and promote the openness and transparency of transactions.

　　Four, the appropriate Chinese medicine and Chinese medicine medical services into the scope of medical insurance payment.

　　(seven) in accordance with the provisions of the qualified Chinese herbal pieces, Chinese patent medicines, Chinese medicine preparations in medical institutions, etc. into the medical insurance drug list. The preparation and use of Chinese patent medicines that have been negotiated by the state into the medical insurance catalogue will be included in the monitoring and evaluation. Make full use of the "dual-channel" drug management mechanism, expand the channels of drug use for insured patients to designated retail pharmacies, and better protect the drug demand of insured people. All localities should, according to the fund’s affordability and clinical needs, bring eligible ethnic medicines, Chinese medicine preparations and Chinese medicine pieces from medical institutions into the scope of local medical insurance payment according to procedures, and establish a dynamic adjustment mechanism. Will conform to the "prescription management measures" and "hospital Chinese herbal pieces management norms" but beyond the "People’s Republic of China (PRC) Pharmacopoeia" provisions of the commonly used dose of Chinese herbal pieces into the scope of medical insurance payment.

　　(eight) to increase the tilt of traditional Chinese medicine characteristics and advantages of medical services. Encourage all localities to incorporate appropriate technologies of traditional Chinese medicine with definite curative effect and advantages of traditional Chinese medicine into the scope of medical insurance payment. Standardize the use of Chinese medicine medical services, medical insurance payment shall not set unreasonable restrictions.

　　(nine) pay attention to the positive role of traditional Chinese medicine in the prevention and treatment of major epidemics, and establish and improve the mechanism of bringing the expenses of traditional Chinese medicine into the scope of medical insurance payment according to the regulations.

　　Five, improve the payment policy suitable for the characteristics of Chinese medicine.

　　(ten) to strengthen the management of the total medical insurance budget, reasonably determine the total index according to the characteristics of Chinese medical institutions, and increase the support for primary medical and health institutions to carry out Chinese medicine services. For the compact county medical community led by Chinese medical institutions, the total budget is appropriately tilted.

　　(eleven) to promote the reform of payment methods for Chinese medical insurance. General TCM medical services can continue to be paid according to the project. Explore the implementation of TCM disease payment according to the disease score, select TCM disease, reasonably determine the score, and implement dynamic adjustment. Priority will be given to the dominant diseases of traditional Chinese medicine released by the state into the scope of payment by disease. Medical institutions of traditional Chinese medicine can temporarily not pay according to the disease diagnosis related grouping (DRG), and appropriately improve the coefficients and scores of medical institutions of traditional Chinese medicine and diseases of traditional Chinese medicine in areas where DRG and disease score payment have been implemented, fully reflecting the characteristics and advantages of traditional Chinese medicine services. For the dominant diseases of traditional Chinese medicine that need long-term hospitalization, such as rehabilitation and hospice care, they can be paid according to the bed day. Explore the long treatment cycle, controllable risks and continuous treatment of TCM diseases, carry out daytime TCM medical services, implement payment according to diseases, reasonably determine the payment standard, and the state uniformly formulate the catalogue of diseases in day wards.

　　(twelve) support primary medical institutions to provide Chinese medicine services. Encourage designated Chinese medical institutions to undertake the diagnosis and treatment of chronic and special diseases in medical insurance clinics within the scope of their diagnosis and treatment, and give full play to the role of Chinese medicine in the prevention and treatment of chronic and special diseases. Pay per head in qualified primary medical and health institutions, encourage family doctors to provide Chinese medicine services, and encourage Chinese medicine doctors and qualified Chinese medicine clinics to form teams to carry out family doctor contract services. Medical insurance departments should strengthen agreement management, improve settlement methods, strengthen performance evaluation, improve incentive policies for surplus retention, and encourage and guide grassroots medical and health institutions to provide appropriate Chinese medicine services.

　　(13) Support the construction of a compact medical consortium led by medical institutions of traditional Chinese medicine, implement the payment policy of total payment, strengthening supervision and assessment, retaining the balance and sharing the reasonable cost overruns, promote the sinking of high-quality medical resources of traditional Chinese medicine to primary medical and health institutions, and enhance the service capacity of primary Chinese medicine.

　　Six, strengthen the supervision of medical insurance funds.

　　(fourteen) to strengthen the daily supervision and management. We will improve the normal daily supervision mechanism, strengthen the expenditure management of medical insurance funds in designated Chinese medicine medical institutions and Chinese medicine retail pharmacies, and prevent medical institutions from defrauding medical insurance funds such as false medical treatment, hospitalization, drug purchase, and false diagnosis and treatment projects. Make full use of medical insurance intelligent monitoring, on-site inspection and other means to strengthen supervision and inspection of designated Chinese medicine institutions, promote designated Chinese medicine institutions to implement the main responsibility of fund use, rationally use medical insurance funds, and standardize the behavior of Chinese medicine diagnosis and treatment services.

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

　　Local medical insurance departments and departments in charge of traditional Chinese medicine should attach great importance to medical insurance to support the inheritance, innovation and development of traditional Chinese medicine, strengthen organizational leadership, do a good job in departmental coordination, and formulate policies and measures for medical insurance to support the inheritance, innovation and development of traditional Chinese medicine in light of local conditions. The National Demonstration Zone for Comprehensive Reform of Traditional Chinese Medicine should take the lead in formulating policies and measures for medical insurance to support the inheritance, innovation and development of traditional Chinese medicine. The National Health Insurance Bureau and state administration of traditional chinese medicine will select some areas to carry out medical insurance to support the inheritance, innovation and development of traditional Chinese medicine.

　　State administration of traditional chinese medicine, National Health Insurance Bureau

　　December 14th, 2021