The regulations on the supervision and management of medical security funds were passed at the State Council executive meeting on Dec 9, 2020, and will become effective on May 1, 2021, according to a State Council decree signed by Premier Li Keqiang on Jan 15 and issued on Feb 19.
The regulations apply to the utilization and supervision of medical security funds, including basic healthcare insurance and medical aid funds.
The payment coverage of medical security funds should be set by the healthcare insurance department under the State Council, it said.
Also, it defines the rights and responsibilities of medical insurance authorities, designated medical institutions, and the insured.
A unified medical insurance management system should be built nationwide, offering standard services in villages, townships, counties, cities, and provinces.
Medical insurance authorities should build a management system for business, finance, security, and risks, and disclose the income, expenditure, and balance of medical insurance funds to the public on a regular basis.
Medical insurance authorities should establish a collective negotiation mechanism with designated medical institutions to set down their budget and payment schedule for medical insurance funds.
Designated medical institutions should provide medical services according to regulations, improve service quality and make reasonable use of medical insurance funds.
Designated medical institutions should establish an internal management system for the use of medical security funds and organize training in systems and policies related to medical insurance funds. In addition, their staff members should implement real-name medical treatment and drug purchase management provisions.
The insured should use their own medical security certificate when seeking medical treatment and purchasing medicine. They also have the right to request that designated medical institutions issue expense documents and other materials.
To ensure effective supervision and management of medical insurance funds, the departments of medical insurance, health care, traditional Chinese medicine, market supervision and management, finance, audition, and public security, should cooperate with each other to establish mechanisms for communication, coordination, and case transfers.
The administrative department of medical security should enhance information exchanges and sharing with relevant departments. They should create supervision and management by promoting information technology and building a unified, efficient, compatible, convenient, and safe medical security information system.
The administrative department of medical security under the State Council should establish a credit management system for designated medical institutions and personnel, and conduct supervision and management based on credit ratings.
Channels for reporting complaints should be open. Complaints should be handled in a timely manner in accordance with the law, and information about the whistleblowers should be kept confidential.