Legal analysis: The scope of payment of the basic medical insurance fund is determined by the competent department of medical security in the State Council, and the opinions of the competent department of health and health, the competent department of traditional Chinese medicine, the drug supervision and administration department and the financial department in the State Council are listened to. The people's governments of provinces, autonomous regions and municipalities directly under the Central Government may, in accordance with the relevant provisions of the state, supplement and determine the specific items and standards paid by the basic medical insurance fund within their respective administrative areas, and report them to the competent medical security department of the State Council for the record. The competent department of medical security in the State Council should carry out evidence-based medicine and economic evaluation on the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, etc. included in the scope of payment, and should listen to the opinions of the competent department of health and health in the State Council, the competent department of traditional Chinese medicine, the drug supervision and administration department, the financial department and other relevant parties.

Legal basis: People's Republic of China (PRC) Basic Medical Care and Health Promotion Law.

Eighty-second basic medical service fees are mainly paid by basic medical insurance funds and individuals. The state raises basic medical insurance funds through various channels according to law, and gradually improves the mechanism of sustainable financing and adjusting the level of basic medical insurance protection. Citizens have the right and obligation to participate in basic medical insurance according to law. Employers and employees pay basic medical insurance premiums for employees in accordance with state regulations. Urban and rural residents pay the basic medical insurance premiums for urban and rural residents according to regulations.

Article 83 The state establishes a multi-level medical security system with basic medical insurance as the main body, supplemented by commercial health insurance, medical assistance, mutual medical care for employees and medical charity services. The state encourages the development of commercial health insurance to meet the diverse health protection needs of the people. The state improves the medical assistance system to ensure that eligible people in need get basic medical services.

Article 84 The State establishes and improves the consultation and negotiation mechanism between the basic medical insurance agency and the medical and health institutions designated by the agreement, scientifically and reasonably determines the payment standard and payment method of the basic medical insurance fund, guides the medical and health institutions to make rational diagnosis and treatment, promotes the orderly flow of patients, and improves the utilization efficiency of the basic medical insurance fund.

Eighty-fifth basic medical insurance fund payment scope shall be formulated by the competent department of medical security in the State Council, and listen to the opinions of the competent department of health and health, the competent department of traditional Chinese medicine, the drug supervision and administration department and the financial department in the State Council. The people's governments of provinces, autonomous regions and municipalities directly under the Central Government may, in accordance with the relevant provisions of the state, supplement and determine the specific items and standards paid by the basic medical insurance fund within their respective administrative areas, and report them to the competent medical security department of the State Council for the record. The competent department of medical security in the State Council should carry out evidence-based medicine and economic evaluation on the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards, etc. included in the scope of payment, and should listen to the opinions of the competent department of health and health in the State Council, the competent department of traditional Chinese medicine, the drug supervision and administration department, the financial department and other relevant parties. The evaluation results should be used as the basis for adjusting the payment scope of the basic medical insurance fund.