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.
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