Monday, 23 January 2017

G.O.MS.No.12 , Dated: 23-01-2017. Escalation of Costs pertaining to Employee Health Scheme.

    


   GOVERNMENT OF  ANDHRA PRADESH                               ABSTRACT

HM&FW – EHS  -  Escalation of Costs pertaining  to Employee  Health Scheme  – Orders  - Issued.

       HEALTH, MEDICAL  AND FAMILY                    WELFARE (I.1) DEPARTMENT 
     G.O.MS.No. 12           Dated: 23-01-2017  

 ORDER :
To  cater  to  the  request  of  hospitals  empanelled  with Dr. NTR-Vaidya  Seva Trust and  as per  their  submissions  given  to Trust,  Government  of Andhra Pradesh  after careful review of various  issues  related  to  execution  of  existing  and  proposed coverage  plans,  hereby approved  the  following  additions and improvements in  Employee  Health  Scheme  (EHS)  design  :

1.  Since  last  price revision  as  per G.O.Ms.No.176 dated  1st  Nov 2013,  to  accommodate  the cost  of inflation since Dec  2013 till  2016,  cost  of  EHS  packages  would  be  revised  by  CPI cumulative  from 1st  Dec 2013  till Dec 2016.  This would amount to  1/3rd  of  CPI  of  2013 (Dec  2013-March  2014),  CPI of  2014,  2015 and  2016 amounting  to (1/3)  of  10.92%  + 6.37% +  5.88% +  5.22% respectively  equal  to  21.11%.

2.  Cost  escalations  shall  be  extended  to  all 1885 procedures under EHS  from  1st February,  2017 by  21.11%.

3.  Thereafter in  every  subsequent  year,  preceding  years’  CPI shall  be  automatically made  applicable  on package  costs  with effect from 1st  April  of  the subsequent  year.

 4.  The  principles  of  Insurance  shall  be  made  applicable,  in  a manner  that  for  NABH  empanelled  hospitals,  NABH  incentives shall be  made  applicable  uniformly  for  all categories  of patients  under all schemes.  The rate  shall  be  placed realistically  at 2%  above  the  revised  EHS package  costs.

5.  Dr. NTR-VS Trust shall empanel clinical  audit agencies  and it would be  mandatory for  hospitals to  undergo  third party clinical audit from  any of  the  empanelled agencies,  for appropriateness and adequacy  of care. Non-compliance  to audit  shall attract a penalty of  2%.  The  clinical  audit  sample size  and periodicity  shall be  notified  by  Dr. NTR-Vaidya Seva Trust.

 6.  Hospitals  would  need  to  undergo fresh  empanelment before 31st  March  2017 declaring  all specialties they have. Empanelment application shall be  made  for  all specialities existing  with  the respective  hospitals and  not  piece-meal basis  to reduce  rejection of patients.

7.  Coverage  in Hyderabad hospitals shall  be  extended  only for

        a.  Cancer Care and  Paediatric  Cardiac Surgery  for all  EHS beneficiaries and  their family  members, since  AP  does  not have  adequate  cancer  care  and paediatric cardiac surgery facilities.

        b.  For  all other  procedures, coverage  in empanelled hospitals at Hyderabad shall be  valid only  for  pensioners, employees  working  in  secretariat  and  Heads  of  the departments and their  families.

        c.  The empanelment  facility  for cancer care  shall  be extended  for hospitals in  the cities of  Bangalore and Chennai to  all  EHS  beneficiaries and their  families.

8.  The empanelled  hospitals  shall  be  required  to  meet  preaccreditation  status for NABH  within  2  years  of  empanelment and full accreditation (appropriate  the level and size  of hospital)  within  4  years  of  empanelment.  This  timeframe would be  valid for  all hospitals  from  the  date  of  fresh empanelment  of  the  all  respective  hospitals.

      2. The above guidelines  shall also  be  applicable  for Working Journalists Health  Scheme  (WJHS).

      3. The  Chief Executive  Officer,  Dr. NTR  Vaidya Seva Trust,  A.P., Hyderabad shall  take  necessary action  accordingly.

 (BY ORDER AND IN THE NAME OF  THE        GOVERNOR  OF  ANDHRA  PRADESH)

            Dr. POONAM MALAKONDAIAH                          PRINCIPAL  SECRETARY  TO GOVERNEMNT




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