The Office of the National Healthcare Security Administration and the Office of the Ministry of Finance recently issued a notice on doing a good job in the prepayment of medical insurance funds, requiring the unification and improvement of the basic medical insurance fund prepayment system at the national level, standardizing processes, strengthening management, and effectively improving the efficiency of fund utilization. The relevant person in charge of the National Healthcare Security Administration stated that doing a good job in prepaying medical insurance funds is one of the incremental policies of medical insurance. We must adhere to using "prepayments" as "empowerment funds" to alleviate the pressure of medical expenses in designated medical institutions, effectively empower their sustainable development, and provide better medical security for insured people, promote the stable operation of drug and consumables enterprises, and promote the coordinated development and governance of the "three medical" industries, better serve and guarantee the overall macroeconomic development, and contribute to the stable operation of society. The notice clarifies the regulatory requirements from the aspects of policy system arrangement, application process, accounting and supervision, mainly reflecting the "three clarifications" and "three norms". The first is to clarify the policy connotation. Prepayment is the working capital prepaid by the medical insurance department to designated medical institutions for medical expenses such as drug and medical consumables procurement. It cannot be used for non-medical expenses such as infrastructure investment, daily operation, and debt repayment of medical institutions. The special prepayment of the medical insurance fund for centralized procurement of drugs and medical consumables shall be implemented in accordance with the original regulations. The second is to clarify the disbursement conditions. In principle, the conditions and standards for disbursing prepayments shall be based on the cumulative balance of the medical insurance pooling fund in the pooling area and the operational risk level of the medical insurance fund. Thirdly, clarify the expenditure standards. The approved standard is based on the average monthly expenditure of relevant medical insurance funds in the previous one to three years, and the basic scale of advance payment should be reasonably determined. The advance payment scale should be around one month. The "three standards" include standardized process management, standardized accounting, and standardized fund supervision. In terms of regulating fund supervision, the notice requires medical insurance departments to include medical insurance prepayments in service agreements and refine relevant terms. At the same time, clarify the situation where the medical insurance department recovers the advance payment. For those that cannot be recovered, stop disbursing medical insurance settlement fees to designated medical institutions and apply for judicial proceedings to ensure the safety of the medical insurance fund. The notice also specifies that each region should formulate, modify, and improve its own prepaid management measures and implementation rules based on actual conditions. (New Society)
Edit：Chen Jie Responsible editor：Li Ling
Source：People's Daily
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