AP GO.176- Notification and adoption of ‘Final Therapy Prices’ under EHS

AP GO.176- Notification and adoption of Final Therapy Prices, Government of Andhra Pradesh, Health Medical and Family Welfare Department have issued GO.No. 176 on November 1, 2013. This Government Order for Notification and adoption of ‘Final Therapy Prices’. These details are provided here.

Government of Andhra Pradesh
HEALTH MEDICAL AND FAMILY WELFARE
GO.MS.No.176; Date: 01/11/2013

Health, Medical and Family Welfare – Employees Health Scheme – Notification and adoption of ‘Final Therapy Prices’ – Orders – Issued.

ItemDetails
TitleNotification and adoption of Final Therapy Prices
SubjectAP Govt has issued GO 176 Notification and adoption of Final Therapy Prices
CategoryGovt Order
StateAndhra Pradesh
GO NOGO.MS.No.176
GO DateDate: 01/11/2013
Name of the DepartmentHealth Medical and Family Welfare Department
Notification and adoption of Final Therapy Prices

Read the following:

  1. G.O.Ms.No.227 HM&FW (K2) Dept dated 09-06-2006.
  2. G.O.Ms.No.184 HM&FW(M2) Dept dated 14-08-2012.
  3. Govt Memo. No. 21233 /M2/2012-3 HM&FW (M2) Dept dated 06/02/2013.
  4. Representation dated 30-03-2013 received from AP Speciality Hospitals Association (ASHA).
  5. Representation dated:03-04-2013 received from AP Private Hospitals & Nursing Homes Association (APNA).
  6. From the Chief Executive Officer, Aarogyasri Healthcare Trust, Hyderabad letter No.2349 /P&C/F.49/2013 dated 26-04-2013.
  7. Govt Letter No.21233/M2/2012-4 HM&FW(M2) Dept dt.29-04-2013.
  8. From the Chief Executive Officer, Aarogyasri Healthcare Trust, Hyderabad letter No.AST/2349 /P&C/F.49/2013 dated 29-04-2013.
  9. G.O.Ms.No.87 HM&FW (M2) Dept dated 27-06-2013.
  10. From the Chief Executive Officer,Aarogyasri Healthcare Trust Letter No.AST/ 4768 /P&C/F.49/ 2013, dated: 06-09-2013.
  11. Government Memo.No.16977/M2/2010, Dated: 30/10/2013.
  12. From the Chief Executive Officer, Aarogyasri Healthcare Trust, Letter No.AST/ 4768 /P&C/F.49/ 2013, dated: 30-10-2013.
  13. G.O.Ms.No.174, HM&FW (M2) Dept. Dated: 01/11/2013.
  14. G.O.Ms.No.175, HM&FW (M2) Dept. Dated:01/11/2013.

ORDER:
Rajiv Aarogyasri Scheme (RAS) is being implemented by Government from 01.04.2007 to financially assist 233 lakh poor families to avail medical treatment for identified diseases covering 938 In-patient (IP) therapies and 125 follow-up therapies vide G.O. first read above.

The government have also decided to implement a similar cashless scheme (Employees Health Scheme) for Government pensioners and employees with coverage envisaged in APIMA rules, 1972 vide G.O. 2nd read above. Aarogyasri Healthcare Trust, after deliberations and in consultation with specialists, has identified additional IP therapies for inclusion in employees health scheme, in addition to Aarogyasri packages.

AP Speciality Hospitals Association (ASHA) and A P Private Hospitals & Nursing Homes Association (APNA) representing the private hospitals empanelled under Rajiv Aarogyasri Scheme, submitted representations to Government, seeking revision of the package rates for Rajiv Aarogyasri Scheme and also clarifications on certain other issues. In Memo. No. 21233 /M2/2012-3 HM&FW (M2) Dept dated 06-02-2013,

The government have constituted a committee headed by Principal Finance Secretary and consisting of Principal Secretary to Government, Health Medical & Family Welfare Department, Commissioner, A.P. Vaidhya Vidhana Parishad, Director of Medical Education, as members, Chief Executive Officer, Aarogyasri Health Care Trust as member-convenor, and two representatives each from ASHA and APNA as members for examining the grievances of ASHA and APNA.

The Committee, after detailed discussions and deliberations, submitted its recommendations to the Government.

Government-issued orders in the G.O. 9th read above, by notifying the ‘Input Code Book’, ‘Standard Schedule of Rates for 2012-13’, and the ‘Final Therapy Prices ’, for being adopted by the Aarogyasri Health Care Trust for determining the package rates for treatment of patients in empanelled hospitals, for Rajiv Aarogyasri Scheme.

In the letter 10th read above, the Chief Executive Officer, Aarogyasri Healthcare Trust has submitted the ‘Final Therapy prices for Employees Health Scheme’ which include additional therapies in addition to the existing Aarogyasri therapies, prepared basing on the ‘Input Code Book’ and ‘Standard Scheduled of Rates (SSR 2012-13)’ already notified in the G.O. 9th read above. These final therapy prices are inclusive of OP evaluation.

In the G.O., 9th read above, Standard Schedule of Rates for 2012-13 are approved according to which Rs.900/- per day is the rate prescribed for General Ward. The government have decided to consider Rs.1200/- per day for a stay in semi-private ward and Rs.1500/- per day for the private ward in the non-NABH accredited hospitals. In so far as the NABH accredited hospitals are concerned, the rates would be Rs.1500/- per day for semiprivate ward and Rs.2000/- per day for the private ward.

This would be an incentive to the NABH accredited hospitals for promoting quality of health care. The APIMA Rules adopt CGHS norms and the CGHS prescribes incentives to the NABH accredited hospitals for promoting quality of health care. Hence, NABH hospitals are considered for higher tariff so far as hospital stay is concerned. Moreover, the scheme will be reviewed after obtaining the actual data for six months, the rationalization of the above prices for semi-private ward and private wards would also be considered in the review.

The Chief Executive Officer, Aarogyasri Health Care Trust will carefully monitor the implementation of the Scheme and after obtaining the actual data for six months, will place the same before the Steering Committee for considering rationalization of the above prices for semi-private ward and private wards.

Government after careful examination hereby issue the following orders:-
a. List of therapies and the package prices are placed in the Annexure. These shall be adopted by Aarogyasri Health Care Trust for treatment of patients in empanelled hospitals, under the Employees Health Scheme.

b. The Chief Executive Officer, Aarogyasri Healthcare Trust is authorized to include any additional inputs, which may be required during the course of implementation of the scheme, code them, finalise the prices and append the same in the Medical Input Code Book and Standard Schedule of Rates (SSR) subsequently.

c. The following standard schedule of Rates is hereby approved.
i. Stay in Semi private ward Rs.1,200/- per day in non-NABH accredited hospitals and Rs.1,500/- per day in NABH accredited hospitals.
ii. Stay in Private ward Rs.1,500/- per day in non-NABH accredited hospitals and Rs.2,000/- per day in NABH accredited hospitals.

The Chief Executive Officer, Aarogyasri Health Care Trust, Hyderabad shall take further necessary action, accordingly in the matter.

This order issues with the concurrence of Finance (Expr.M&H.1) Department vide their U.O.No.360/A1/Expr.M&H.I/2013, Dated: 26/10/2013.

Download the GO.176 from here

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