Rajiv Gandhi Jeevandayee Arogya Yojana (Rajiv Gandhi Jeevandayee Scheme)

 

 INTRODUCTION OF THE SCHEME:

Government of Maharashtra is implementing Rajiv Gandhi Jeevandayee Arogya Yojana throughout the State in phased manner in order to improve access of Below Poverty Line (yellow card holders) and Above Poverty Line (APL orange card holders) families to quality medical care for identified specialty services requiring hospitalization for surgeries and therapies or consultations through an identified network of health care providers. The RGJAY– Phase-I will cover 30 specialized service categories having 972 procedures and 121 follow up procedures.

In order to ensure that the service providers give quality medical care under the scheme certain minimum standards for the hospitals to be empanelled as defined below

 

 ELIGIBILITY CRITERIA FOR EMPANELLMENT OF HOSPITALS:

 

HOSPITAL / NURSING HOME : Means any Government institution or Private institution in Maharashtra established for indoor medical care and treatment of disease and injuries and should be registered under Bombay Nursing Home Registration (Amendment 2005) Act and PNDT Act &/or Human Organ Transplant Act 1994 (Wherever Applicable).

 

 

 GENERAL CRITERIA :

 

 Basics :

 

 ·         Should have at least 50 inpatient medical beds with adequate spacing and supporting staff as per norms.

 ·         Should have Separate Male and Female General Wards.

 

  Manpower Requirements :

 

Fully qualified doctor(s) of modern medicine should be physically in charge round the clock.

Availability of Qualified/trained paramedics round the clock; availability of specialists in the concerned specialties and support fields within short notice.

Provide the services of a dedicated Medical Officer to work as Rajiv Gandhi Jeevandayee Medical Coordinator (MCO) for the scheme who will be responsible to the Society and the Insurer/MDIndia for doing various activities under the scheme including Health Camps, Follow-up of referred patients from camps, diagnosis, outpatient details,E-preauthorization, Surgeries, Feedback on the patient’s condition and services offered by the hospital during hospital stay of the patients, discharges, deaths if any, follow-up free consultation of the patients and distribution of medicines after discharge etc.

 

   Services:

 

Fully equipped and engaged in providing Medical and Surgical facilities for the respective specialties.

Maintaining complete record as required on day-to-day basis and is able to provide necessary records of the insured patient to the Insurer/MDIndia or his representative as and when required.

Having sufficient experience in the specific identified field.

Minimum one free Health Camp in a village in a week for the screening of the beneficiary families suffering from the identified ailments. Hospital may have a mobile team with diagnostic equipment and team of doctors as specified by the Society for this purpose. Villages shall be identified by the Society in consultation with district administration and communicated to the hospitals. Hospital shall provide services of Medical Camp Coordinator (MCCO) for organizing health camps. The Hospital shall follow the camp policy of the Society.

 

  Records :

 

Hospital should maintain line list of procedures carried out & treatment given in following Proforma.

 

Name of patient

Age

Sex

Address

Diagnosis

Name of surgery / Treatment.

Date of admission

Date of discharge.

Infrastructure :

Safe Drinking water facilities.

 

Fully equipped Operation Theatre of its own wherever surgcal operations are carried out with qualified nursing staff under its employment round the clock.

Post-operative ward with ventilator and other required facilities (wherever required).

ICU facility Monitors, Ventilators, Oxygen facility, Suction facility, Defibrillator, and required other facilities with requisite staff

Shall be able to facilitate round the clock Blood Bank facilities either In-House or Tie-up facility with a nearby Blood Bank.

Shall be able to facilitate round the clock Ambulance facilities either own or Tie-up facility with a nearby Service Provider.

Shall have all necessary infrastructure required for preauthorization round the clock to be obtained electronically by direct access to the web portal of the society.

Provide space and separate RGJAY counter/kiosk as per the design for Aarogyamitras.

Provide Computer with networking (dedicated broadband with minimum 1mbps speed), printer, scanner, bar code reader and digital camera.

Safe Drinking water facilities.

Free Services :

Hospital shall provide following additional benefit to the BPL(Yellow ration card holder) and APL (orange ration card holders with Annual income < Rs. 100000) beneficiary families related to identified system

Provide free food for the patient when hospitalized

Provide transport/transportation charges for patient by cash (onetime transport cost by State Transport or second class rail fare (from Hospital to residence of patient only).

Free OPD consultation.

Free diagnostic tests and medical treatment required for beneficiary families irrespective of surgery.

Others :

The Insurance Company/MDIndia shall provide CUG (Closed User Groups) connection to all MCOs & MCCOs.

The Insurer/MDIndia will provide the computer with broad band connectivity, printer, scanner, bar code reader and digital camera & the same will be installed by the insurer/MDIndia whose cost will be recovered from the claim payment due to the provider for the treatment given out to beneficiaries. The cost of the installation will be recovered and then balance if any made payable to the provider.

IMPORTANT REMARKS

The hospital should update the details of duty Doctors, In-house Doctors, Consultants and Paramedics ONLINE. Addition or Deletion of duty Doctors, In-house Doctors, Consultants and Paramedics is also to be uploaded ONLINE for the approval of Trust/Insurer from time to time. Any change in the shift/plan of work of duty doctors, in-house, consultants and paramedics has to be informed and got approved online before initially such changes.

All the doctors/Specialist who acquired equivalent degree other than those mentioned should have been recognized by MCI & must have been registered with Maharashtra Medical Council. It may be noted that online information provided by the hospital is liable to be cross checked automatically online with Maharashtra medical Council Database and only if matching details are found the workflow will accept the same. In case it is not matching the hospital/doctor may take necessary action to get the registration done by Maharashtra Medical Council before applying online

The Hospital should not exclude any other specialty service deliberately from the scheme in spite of having such facility and agrees to empanel for all the specialties for which adequate infrastructure is available. If it is found the hospital is taking only non-Aarogyasri for select specialities and discouraging admission to Aarogyasri beneficiaries the empanelment of the hospital is liable to be terminated.

The Hospital should intimate the Trust/Insurer prior to the commencement of renovations to be undertaken in the Hospital and declares that the renovations works shall be taken up without interrupting medical services to the patients.

Any false information submitted by the hospital in online application for empanelment. It will be viewed seriously and such applications will be Rejected. It may also be noted that the above are minimum indicative requirements and the hospital shall also provide or establish other requirements as per the indications/directions of the Society.