China\u2019s National Healthcare Security Administration (NHSA) has released the \u201cRegulations on the Management of Medical Insurance Payment Qualifications for Personnel in Medical Security Designated Medical Institutions.\u201d These regulations aim to enhance the rational use of medical insurance funds and maintain fund security through improved management efforts. The document came into effect on January 1, 2025.<\/p>\n\n\n\n
Regulatory Requirements<\/strong> Institutional Responsibilities<\/strong>
According to the new regulations, medical insurance agencies are required to sign medical security service agreements with medical institutions in accordance with established guidelines. This includes strengthening the management of designated medical institution agreements and implementing requirements for the management of medical insurance payment qualifications for relevant personnel. Once the service agreement is signed, relevant personnel practicing (employed) in designated medical institutions can obtain medical insurance payment qualifications as per regulations. They can then provide medical services to insured persons and be included in the scope of medical insurance supervision.<\/p>\n\n\n\n
Designated medical institutions are required to complete the registration and filing of relevant personnel, service commitments, status maintenance, and medical insurance expense declarations as required. The management of medical insurance payment qualifications for relevant personnel can be linked to incentive and constraint management systems, such as annual assessments and internal notifications. Medical security agencies are expected to perform well in scoring management, information verification, and strengthen the management of medical insurance fund audits and settlements.<\/p>\n\n\n\n