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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