TS Employees Health Scheme(EHS) and Journalists Health Scheme new Guidelines for Providing Cashless, qualitative treatment, Employees Health Scheme & Journalists Health Scheme Out-patient Treatment Guidelines for Providing Cashless and qualitative treatment to the State Government Employees, Pensioners, Working & Retired Journalists and their dependent family members
G.O.Ms.No. 98 Dated: 07 06-2017:: GOVERNMENT OF TELANGANA:: HEALTH, MEDICAL AND FAMILY WELFARE (A1) DEPARTMENT:: Health, Medical and Family Welfare – Employees Health Scheme & Journalists Health Scheme – Providing Cashless and qualitative treatment to the State Government Employees, Pensioners, Working & Retired Journalists and their dependent family members – Guidelines for Out-patient Treatment – Orders – Issued.
Read the following:
1. AP Integrated Medical Attendance Rules, 1972 amended from time to time upto G.O.Ms.No.74, HM&FW(K1) Dept,
dt.15-03- 2005 amended in G.O.Ms.No.105, HM&FW(K1) Dept.
2. G.O.Ms.No.184, HM&FW(M2) Dept., Dated: 14-08-2012.
3. G.O.Ms.No.186, HM&FW(M2) Dept., Dated: 14-08-2012.
4. G.O.Ms.No. 174, HM & FW (M2) Department, dt.01.11.2013.
5. G.O.Ms.No. 175. HM & FW (M2) Department, dt: 01-11-2013.
6. G.O.Ms.No. 176, HM & FW (M2) Department, dt: 01-11-2013.
7. G.O.Ms.No. 32, HM & FW (A2) Department, dt: 03-11-2014.
8. G.O.Ms.No.33, HM & FW (A2) Department, dt 13.11.2014.
9. G.O.Ms.No.36 HM & FW (A2) Department, dated 27.11.2014.
10. G.O.Ms.No.40, HM&FW (A2) Department, dated:1-12-2014.
11. G.O.Ms.No.26, HM&FW (A2) Department, dated: 30-3-2015
12. G.O.Ms.No.55, HM&FW (A2) Department, dated: 27-6-2015
13. G.O.Ms.No.64, HM&FW (A2) Department, dated: 27-7-2015.
14. G.O.Rt.No.666, LET&F (IMS) Dept., Dated: 24-09-2016.
15. Govt.Lr.No.9851/A1/2016, Dt: 27-09-2016 of HM&FW(A1)Dept.
16. Minutes of the Committee held on 22-10-2016.
17. Minutes of the Meeting held on 04-11-2016 conducted by the Hon’ble Minister for HM&FW.
18. Lr.No.AHCT/EHS/Accts/102/2016 dt. 22-02-2017 from the Chief Executive Officer(FAC), EHS & JHS, AHCT, Hyderabad
19. G.O.Ms.No.97, HM&FW (A1) Dept., Dt: 07-06-2017
The Chief Executive Officer(FAC), EHS & JHS, AHCT, Telangana, Hyderabad has submitted that in reference 2nd read above, Government have approved the Employees Health Care Fund Scheme (EHF) to provide cashless treatment to all the State Government employees including the State Government pensioners, along with their dependent family members through a network of empanelled hospitals of Aarogyasri Health Care Trust, in lieu of the medical reimbursement system under ‘The Telangana State Integrated Medical Attendance Rules, 1972 (TSIMA Rules, 1972). Simultaneously, in reference 3rd read above, operational guidelines for implementation of the Scheme were issued delineating the role of Government functionary as well as individual beneficiary. Further in reference 4th read above, the Government have revised the EHF scheme and issued orders notifying the “ Employees Health Scheme” (EHS) and its implementation with immediate effect. In the reference 5th read above, operational guidelines for issue of Health Cards have been issued and vide reference 6th read above, Government have fixed final
2. In reference 7th read above, certain modifications have been made to the “EHS” by the Government of Telangana State and directed to implement the Scheme w.e.f. 01.11.2014. The Employees Health Scheme is formulated to provide cashless treatment to the employees and pensioners of the State Government and their dependent family members which will ipso facto replace the existing medical reimbursement system under APIMA Rules, 1972, with additional benefits such as post–operative care and treatment of chronic diseases which do not require hospitalisation and treatment in empanelled hospitals.
3. Further in the reference 13th read above, the Government have decided to provide comprehensive health coverage to the working and retired Journalists in Telangana State similar to the Employees Health Scheme while issuing guidelines for implementation of ‘Working and retired Journalists Scheme’ by Aarogysri Health Care Trust.
4. Government have appointed Chief Executive Officer in reference 14th read above, and reference 15th read above, to execute, supervise and implement the EHS & JHS Schemes while separating the scheme from Aarogyasri Scheme. In Aarogyasri Health Care Trust two schemes will be implemented simultaneously with two Chief Executive Officers, executing their specific schemes;
1) Chief Executive Officer, Aarogyasri Scheme
2) Chief Executive Officer, Employees/Journalists Health Scheme.
5. The AHCT Executive Board have reviewed the implementation of the Employees Health Scheme and Journalist Health Scheme on 22-10-2016 and felt that a Committee shall be formed to review on the packages (Medical, Surgical) and providing outpatient treatment. Accordingly the AHCT Board have constituted the Committee with the following members.
1) Vice-Chancellor & Supdt. MGM General Hospital, Warangal.
2) Director, NIMS, Hyderabad
3) Director of Medical Education, Hyderabad
4) Chief Executive Officer, EHS & JHS, Hyderabad
5) Executive Officer (P&C) AHCT, Hyderabad.
6. The Committee have conducted series of meetings with various associations of Telangana State such as Gazetted Officers, TNGOs, Class-IV, Teachers, Journalists, etc to know the issues regarding providing in-patient services to EHS & JHS beneficiaries. Subsequently the Committee have also conducted series of meetings with all the Specialist Doctors, various Hospital Associations and Telangana Super Speciality Hospital Associations and came to a conclusion regarding providing OP treatment, revision of surgical package prices and unbundling of medical management procedures on the lines of CGHS. The main recommendations of the committee as follows;
1) Providing out-patient treatment through Wellness Centres (in super cession of the G.O. Ms.No.36 dt. 27-11-2014)
2) Grade the hospitals taking into consideration the infrastructure, facilities available, specialists available, etc.
3) Increase of 20% on existing surgical and medical package prices for non-NABH and other-NABH hospitals.
4) Revised surgical packages, Day Care Procedures, Dialysis, medical emergencies, Organ Transplantation, Robotic Surgery, Bone Marrow and unbundling of medical management in
respect of NABH Super Specialty Hospitals.
7. In a meeting held on 04-11-2016 by Hon’ble Minister for Health, Medical and Family Welfare and Chief Secretary to Government, it has been decided to provide O.P. treatment through Wellness Centres and also considered the long pending demands of NABH accredited Super Specialty Hospitals for revised surgical package prices and unbundling of medical management procedures as recommended by the Committee.
8. After careful examination, Government hereby issue the following orders for providing Out-patient (OP) treatment to the employees, pensioners and their dependents in supersession of orders issued in the references 8th and 9th read above.
9. Out-Patient Treatment:
a) Out-patient treatment will be provided through Wellness Centres on common ailments and various specialties and also Indian medicine.
b) Basic lab investigations will be done in the Wellness Centres and high end investigation will be referred.
c) All the medicines / drugs, Surgical items, consumables, Supporting accessories will be provided as per prescriptions.
d) Investigations which are not covered in the above categories will be referred to tie-up Diagnostic Centres (NABL) on cashless referral mechanism.
10. The Chief Executive Officer, EHS & JHS is authorized and delegated powers
a) To establish (14) Fourteen Wellness Centres for providing OP treatment, six (6) Wellness Centres in the Twin Cities i.e. Hyderabad and Secunderabad and eight (8) Wellness Centres in the erstwhile district headquarters of Telangana State for providing OP treatment. If accommodation not sufficient / not available in Government Hospitals, it is permitted to establish Wellness Centre in Rental Buildings.
b) To engage required Staff on outsourcing basis with necessary skills and experience (Doctors/Specialty Doctors/Para Medical Staff / Data Entry Operators/House Keeping/Security, etc) to run Wellness Centres as per the strength shown in Annexure-I for each Wellness Centre.
c) To procure required lab equipment i.e. reagent based equipment or investigation based equipment or rental based equipment / furniture
/ other material as per contract rates of TSMSIDC/NIMS/ESIC or any other institutional procedure or any other prescribed procuring methods mentioned under Financial Rules, as shown in Annexure-II
for each Wellness Centre.
d) To procure Medicines/drugs, surgical items, consumables, kits, reagents, supporting accessories, etc. as per rate contract of TSMSIDC/CGHS/ESI/NIMS, or local empanelled chemists or by following other procuring methods mentioned under Financial Rules.
e) To enter into agreement with private lab service providers on CGHS / NIMS/ESIC model for the investigation services not provided at Wellness Centres.
f) To establish additional Wellness Centres with required staff as per the demand / requirement and load of the EHS & JHS patients with the approval of competent authority.
g) All Wellness Centres shall be established in the similar pattern in respect of Specialties / Staff / Equipment, etc.
11. The budget provision for Rs. 34.02 Crores for Establishment of Wellness Centres, Rs. 91.00 Crores for Medicines/Durgs, Rs. 45.20 Crores for Out- patient investigations shall be made exclusively for Wellness Centres.
12. These orders will come into force with effect from 17.12.2016.
13. This order issued with the concurrence of Finance (EBS.V) Department vide their U.O. Note No. 6246/215/A2/EBS.V/2017, Dt: 06/06/2017.
(G.O.Ms.No.98 HM & FW (A1) Dept., dt: 07-06-2017)
STAFF TO BE POSITIONED IN EACH WELLNESS CENTRE
|SNo.||Medical Officers MBBS &SPl.||No. Of Persons|
|2||Specialists (Ortho/Cardiologist/Any other specialty)||3|
|13||Lab USG(Ultra Sound)||1|
|18||Computer Data Entry||4|
|20||Ward Boy / Office Assistant||3|
|22||Sr Executive HR||1|
EQUIPMENT TO BE PROVIDED IN EACH WELLNESS CENTRE
|Equipment for Lab Tests|
|1||Semi Auto Analyzer CHEM-7||1|
|2||Cell Counter 3 Part||1|
|5||Fully Automated Bio-Chemistry Analyzer with accessories, CPU, Monitor, Printer||1|
|6||Electrolytes (Cornley AcculyTc-3P)||1|
|9||Haemo Mixer (SR-20A)||1|
|10||HBA1 C machine||1|
|12||Mini Vidas – Immune Chemistry analyses||1|
|14||Auto clave front loading||1|
|16||x-ray developing unit||1|
|20||Light cure unit||1|
|26||Soft hand balls||3|
|Electro Therapy Equipment|
|35||CR-System (AGFA) with computer, Table and other accessories||1|
|36||ECG machine with accessories||1|