G.O.No:12 Dt:23-1-17 EHS - Escalation of Costs pertaining to Employee Health Scheme – Orders - Issued

To cater to the request of hospitals empanelled with Dr. NTR-Vaidya Seva Trust and as per their submissions given to Trust, Government of Andhra Pradesh after careful review of various issues related to execution of existing and proposed coverage plans, hereby approved the following additions and improvements in Employee Health Scheme (EHS) design : 1. Since last price revision as per G.O.Ms.No.176 dated 1

1. Since last price revision as per G.O.Ms.No.176 dated 1st Nov 2013, to accommodate the cost of inflation since Dec 2013 till 2016, cost of EHS packages would be revised by CPI cumulative from 1st Dec 2013 till Dec 2016. This would amount to 1/3rd of CPI of 2013 (Dec 2013-March 2014), CPI of 2014, 2015 and 2016 amounting to (1/3) of 10.92% + 6.37% + 5.88% + 5.22% respectively equal to 21.11%. 
2. Cost escalations shall be extended to all 1885 procedures under EHS from 1st February, 2017 by 21.11%.
3. Thereafter in every subsequent year, preceding years’ CPI shall be automatically made applicable on package costs with effect from 1st April of the subsequent year. 
4. The principles of Insurance shall be made applicable, in a manner that for NABH empanelled hospitals, NABH incentives shall be made applicable uniformly for all categories of patients under all schemes. The rate shall be placed realistically at 2% above the revised EHS package costs. 
5. Dr. NTR-VS Trust shall empanel clinical audit agencies and it would be mandatory for hospitals to undergo third party clinical audit from any of the empanelled agencies, for appropriateness and adequacy of care. Non-compliance to audit shall attract a penalty of 2%. The clinical audit sample size and periodicity shall be notified by Dr. NTR-Vaidya Seva Trust. 

Hospitals would need to undergo fresh empanelment before 31st March 2017 declaring all specialties they have. Empanelment application shall be made for all specialities existing with the respective hospitals and not piece-meal basis to reduce rejection of patients.

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