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G.O.Ms.No.82–Escalation of costs pertaining to Employees Health Scheme-amendments

G.O.Ms.No. 82 Dated:18 /05/2017-HM & FW Dept - Employees Health Scheme – Escalation of costs pertaining to Employees Health Scheme - Certain amendments – Orders

GOVERNMENT OF ANDHRA PRADESH
ABSTRACT

HEALTH, MEDICAL AND FAMILY WELFARE (I.1) DEPARTMENT

G.O.Ms.No. 82                                                                                      Dated:18 /05/2017
                                                                                                          
 Read:


                       G.O.Ms.No. 12, HM & FW (I.1) Dept., dt: 23.01.2017.

-o0o-

ORDER:

In the G.O. read above, Government has issued orders pertaining to Employees Health Scheme enhancing the prices of procedures by 21.11% applicable from 1st February , 2017.

2.     In addition to the escalation of prices under Employees Health Scheme and Working Journalists Health Scheme, certain orders were issued by the Government with respect to NABH incentive to the network hospitals having full NABH accreditation, empanelment of hospitals and clinical audit by Dr.NTR Vaidyaseva Trust. 

3.       Government, after careful examination of the matter,  hereby issues the following amendments to the above G.O read above.

Present
Amendment
Point No. 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.
Incentive for NABH accredited network hospitals under EHS and WJHS shall be 11% over and above the package prices and 2% incentive under Dr.NTRVS over and above the package prices.
Point No. 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 Vaidyaseva Trust.
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 Vaidyaseva Trust. The Audit changes will be paid by the Dr.NTR Vaidyaseva Trust.
Point No.6
Hospitals would need to undergo fresh empanelment before 31st March 2017 declaring all specialties they have. Empanelment application shall be made for all specialties existing with the respective hospitals and not piece-meal basis to reduce rejection of patients.
No fresh empanelment is needed for already empanelled hospitals.  Empanelment shall be made for all additional specialties existing with the respective hospitals within 4 months from the date of issue of this order.

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

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

Dr.POONAM MALAKONDAIAH

PRINCIPAL SECRETARY TO GOVERNMENT