国家医保局近日修订印发了2026版医保服务协议范本，分别印发《定点医疗机构医疗保障服务协议范本(2026版)》和《定点零售药店医疗保障服务协议范本(2026版)》1。新版范本在2024版基础上进一步完善，制定了协议管理负面清单，明确划定了定点医药机构依法依规履约行为的底线1。
新版范本强调自愿平等协商原则，并通过医保基金预付、缩短结算周期、加强信息共享、优化经办服务等措施支持医药机构发展1。对违反协议约定的行为，医保部门依据协议采取处理措施，直至解除医保服务协议；涉嫌犯罪的情形依法追究刑事责任1。
The National Medical Insurance Bureau has recently issued revised service agreement templates for designated medical institutions and retail pharmacies 1. The updated templates build upon the 2024 versions and include two key documents: the Designated Medical Institution Medical Insurance Service Agreement Template (2026 Edition) and the Designated Retail Pharmacy Medical Insurance Service Agreement Template (2026 Edition) 1.
The new templates establish a management negative list that defines the baseline boundaries for compliant conduct by designated medical and pharmaceutical institutions 1. The framework emphasizes voluntary and equal negotiation principles while implementing measures to support the development of medical and pharmaceutical organizations, including medical insurance fund prepayment, shortened settlement cycles, enhanced information sharing, and improved administrative services 1.
For violations of agreement terms, the bureau will apply remedial measures based on the specific violations, ranging from administrative sanctions to termination of the medical insurance service agreement 1. Cases involving suspected criminal activity will be referred for criminal prosecution 1.
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