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29 October, 2014

G.O.Ms.No.135, Dt:29-10-2014 :: Detailed Guidelines on  Out-patient (OP) Treatment for Chronic Ailments under EHS

G.O.Ms.No.135, Dt:29-10-2014 :: Health, Medical and Family Welfare – Employees Health Scheme (EHS) – Detailed Guidelines on  Out-patient (OP) Treatment for Chronic Ailments  - Issued.

References:
1. G.O.Ms.No.174   HM&FW (M2) Dept dated  01-11-2013.
2. G.O.Ms.No.175   HM&FW (M2) Dept dated  01-11-2013.
3. G.O.Ms.No.176  HM&FW (M2) Dept dated  01-11-2013.
4. G.O.Ms.No.26 HM&FW (M2) Dept dated 05-02-2014.
5. G.O.Ms.No.117 HM&FW (I.1) Dept dated 12-08-2014.
6. From the CEO., AHCT., letter No.1159/P&C/EHS/2014, dated 03-03-2014.
7. G.O.Ms.No.134, HM&FW (I.1) Dept dated.29 -10-2014.

ORDER:

1. In the G.O. first read above, as amended in the G.Os., 4th  and 5th  read above, the then  Government of Andhra Pradesh launched the “Employees Health Scheme”  (EHS) with effect from 05-12-2013, to provide cashless treatment to the employees, pensioners and their dependent family members in empanelled network hospitals for the listed therapies notified in G.O.Ms.No.176 HM&FW (M2) Dept dated 01-11-2013, and this scheme ipso facto replaces the existing reimbursement system under APIMA Rules, 1972. In para 4.2.2.1 of the G.O., first read above it is mentioned that Out Patient (O.P)  treatment for pre-defined long-term (Chronic) diseases will be provided in notified hospitals and that orders on the modalities and provision of budget to the notified hospitals will be issued   separately.  In his letter 6th read above, the Chief Executive Officer, Aarogyasri Healthcare Trust had submitted proposals for issuing guidelines on ‘chronic OP treatment’.

2.  Consequent on reorganization of Andhra Pradesh, Government have reviewed the implementation of the Employees Health Scheme and has decided that out patient treatment for chronic  diseases, including consultation, medicines and diagnostics shall be provided in the notified Government Hospitals and the expenditure on this would be met from within 15% of the total estimated annual budget of Rs.220 crores.

3. Accordingly, after careful examination, Government hereby issue the following guidelines for Chronic Out-Patient treatment in notified Government Hospitals:

3.1. Out-Patient Treatment for Chronic Ailments:

• Chronic diseases that require OP treatment include those ailments like non communicable diseases (NCDS) such as Diabetes, Hypertension, Coronary Artery diseases, cerebro-vascular diseases, Cancers, Renal failure; communicable diseases such as Tuberculosis, Leprosy, etc., post-surgical, post-traumatic conditions, etc., all of which require longer-term sustained medical treatment.
• For chronic OP Treatment  in the Area Hospital / District Hospital / Teaching Hospital, there will be exclusive special clinic for EHS patients from 2. PM to 4 PM on week days .
• During the special clinic time a consultant doctor , Pharmacy , Radiology services and clinical laboratories services along with sample collection will be available.
• A fee of Rs.50/- for board specially consultant and Rs.100/- for super speciality consultant will be paid for a every EHS OP case which is seen and registered in the online system.

• Commissioner, of APVVP in case of Area Hospitals /  Superintendent of District Hospitals / Superintendent of the Teaching Hospital will provide the needed computer infrastructure, network connectivity and make arrangements for online registration of OP cases. HDS funds, including accruals from Aarogyasri revenues may be utilized for this purpose.
• Drugs will be supplied to the notified hospitals by APMSIDC, as per their indent and intern APMSIDC will receive the budget from the EHS fund managed by the Aarogyasri Trust.

3.2   Yearly medical check-up
• All the employees above 40 years will be eligible for a free medical check up in any  ‘notified hospital’ once in a year consisting of comprehensive services detailed instructions in this regard are being issued separately .

4. The expenditure towards ‘chronic OP treatment’, would be met from the EHS budget.

5. This order issues with the concurrence of Finance Department vide their U.O. No. 304/A1/EBS.V/2014, dt.29-10-2014

Download G.O.Ms.No.135, Dt:29-10-2014

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