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ELIGIBILITY CRITERIA FOR EMPANELLMENT OF HOSPITALS
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 INTRODUCTION: |
| Government of Maharastra is implementing Mahatma Jyotirao Phule Jan Arogya Yojana
Scheme throughout the State for treating serious ailments requiring
hospitalization. The scheme provides financial protection to families living
below poverty line up to Rs. 1.5 lakhs in a year. The objective of the scheme is
to improve access of BPL families to quality medical care through an identified
network of health care providers. A total of 975 (Surgical & Medical)
procedures in identified specialties are covered under the schemes.
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| The identified Network Hospitals are required to implement all
MJPJAY schemes sponsored by Government of Maharastra. |
| 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:
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 A.
REQUIREMENTS |
| I Definition
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| 1) HOSPITAL / NURSING HOME: Means any premises used or intended to be used, for the reception of persons suffering from any sickness, injury or infirmity and the providing of treatment and nursing for them and includes a maternity home; and the expression to ‘carry on a nursing home’ means to receive persons in a nursing home for any of the aforesaid purposes and to provide treatment or nursing to them. They include maternity homes and day care centres as well. Nursing homes shall be registered with Maharashtra Nursing homes registration act. |
| 2) Specialist Doctor: He/she is a doctor holding additional medical qualification in addition to MMBS. He/she shall be registered with Maharashtra medical council for additional qualification. |
| 3) Bed Eligibility: Minimum 30 beds for multispecialty hospital. Relaxation may be given for hospitals exist in aspirational and tribal districts/Talukas. |
4) Following single speciality hospitals are considered for Empanelment:
- Ophthalmology
- Orthopaedic & Polytrauma
- Neonatal & Paediatric Medical Management, Paediatric Surgery
- Oncology
- Burns
- Nephrology (Maintenance Haemodialysis).
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 II
Infrastructure and Expertise (General): |
| The hospital should have the following Expertise & Infrastructure
as per guidelines: |
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Minimum 30 inpatient medical beds with adequate spacing for each bed and supporting staff as per norms.
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Atleast one in-house surgeon and or in-house physician (MD) shall be available for empanelment of Surgical and Medical packages respectively.
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All the doctors working in the hospitals whether fulltime or part-time should be registered under Maharashtra Medical Council. |
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The hospital should have at least minimum of 3 duty doctors, for bed strength of 50 and above. The doctors mentioned at (b) above may also act as duty doctors. Round- the-clock, availability of Duty Doctors & Paramedic staff |
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Round- the-clock, availability of Duty Doctors &
Paramedic staff |
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In-house round-the-clock basic diagnostic facilities for biochemical, pathological and radiology tests such as Calorimeter, Auto analyzer, Microscope, X-ray, E.C.G, USG. Etc, round-the-clock lab and imageology support. |
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Casualty should be equipped with Monitors, Defibrillator, Crash Cart, Resuscitation equipment, Oxygen and Suction facility and with attached toilet facility. |
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Fully equipped Operation Theatre along with required equipments as mentioned in the specific requirements for each Specialty. |
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Post-op ward with adequate number of Monitors, Ventilators and other required facilities. |
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ICU facility with Monitors, Ventilators, Oxygen facility, Suction facility, Defibrillator, and required other facilities & requisite staff. |
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Separate male and female wards with toilet and other basic
amenities. |
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Round-the-clock availability of specialists in the
concerned specialties having sufficient experience and availability of
specialists in support fields with short notice. |
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Round-the-clock advanced diagnostic facilities either
‘In-House’ or with ‘Tie-up’ with a nearby Diagnostic Center. |
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Round-the-clock Blood Bank facilities either ‘In-House’ or
with ‘Tie-up’ with a nearby Blood Bank. |
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Round-the-clock Physiotherapy centre facilities either
‘In-House’ or with ‘Tie-up’ with a nearby Physiotherapy Center, wherever it is
applicable. |
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Round-the-clock own Ambulance facilities. |
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Records Maintenance: Maintain complete records as required
on day-to-day basis and is able to provide necessary records of hospital /
patients to the Society/Insurer or his representative as and when required. |
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24 Hrs In-house pharmacy |
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Safe drinking water facilities. |
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Generator facility with required capacity suitable to the
bed strength of the hospital should be installed. |
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Bio Medical waste management facility available |
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Fire Fighting system available. |
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| 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 Society/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. |
 III
Expertise & Infrastructure (Specific)
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 A.
For Empanelment of Cancer Therapy |
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Services of fully qualified Medical Oncologist, Radiation Oncologist and
Surgical Oncologist – all the specialties should be available in the hospital.
Equipment for Cobalt therapy, Linear accelerator and Brachy therapy – all or
either can be empanelled for Cancer Surgeries and Chemo and Radio-Therapies.
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| Note: A combination of both professional and the
equipment is essential.
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 B.
For Empanelment of Poly Trauma |
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Shall have Emergency Room Setup with round the clock dedicated duty doctors of
Modern Medicine Shall have round the clock anesthetist services Shall be able
to provide round the clock services of Neuro-surgeon, Orthopedic Surgeon, CT
Surgeon and General Surgeon, Vascular Surgeon and other support specialties
wherever applicable.
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Shall have dedicated round the clock Emergency theatre, Surgical ICU, Post-Op
Setup with qualified staff.
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Shall be able to provide necessary cashless diagnostic support round the clock
including specialized investigations such as CT, MRI, emergency biochemical
investigations.
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| C.
For Empanelment of Prostheses (Artificial limbs) |
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Shall have full time services of Orthopedic Surgeon to be empanelled to provide
prostheses package under the scheme. Shall facilitate supply, fitting of
appropriate prosthesis and gait training of patient by physiotherapist. Shall
ensure that an appropriate prosthesis is prescribed based on occupation of the
person and standard prosthesis is supplied as per quality norms of BIS (Bureau
of Indian Standards).
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Shall also facilitate free replacement of leather parts and ensure total
replacement of Prosthesis in case of damage during guarantee period of 3 years
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 IV
Specialty wise specific requirements |
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General Surgery |
| Qualified M.S (General Surgeon) or equivalent with
experience of atleast 100 Laparoscopic Procedures |
| Well equipped O.T with Laparoscopic equipment & Trained
staff |
| Well equipped Post Operative ward and ICU facilities |
| Support speciality of General Medicine and Pediatrics |
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Orthopedic Surgery |
| Qualified M.S Ortho. or D.Ortho or DNB (Ortho.)
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| Well equipped theatre with C-Arm facility |
| Trained paramedics |
| Well equipped Post Operative ward and ICU facilities |
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Obstetrics and Gynecology |
| Qualified M.S (OBG) or DGO or DNB (OBG) with experience of
atleast 100 Laparoscopic Procedures |
| Well Equipped theatre with Laparoscopic equipment |
| Well equipped Post Operative ward and ICU facilities |
| Functioning obstetric unit with support services of
Pediatrician |
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Ophthalmology |
| Qualified M.S (Ophthalmologist) or D.O or DNB (Oph.) |
| Optometry facility |
| Surgeon trained in Vitro-Retinal, Orthoptics and Pediatrics
Ophthalmology |
| Well equipped theatre facility |
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ENT |
| Qualified M.S (ENT) or D.L.O or DNB (ENT) |
| Well equipped theatre with Operating Micro Scope &
Endoscopic equipment as applicable. |
| Well equipped Post Operative ward and ICU facilities |
| Audiology support |
| ENT Op facilities |
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General Medicine |
| Qualified M.D (General Medicine) or DNB (General Medicine) |
| Well equipped AMC & ICU Facilities |
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Pediatrics
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| Qualified M.D (Paed.) or D.C.H or DNB (Paed.) |
| Well equipped PICU/NICU
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Dermatology |
| Qualified M.D (Derm.) or M.D (DVL) or D.D.V.L or DNB (DVL) |
| Well equipped AMC with Physician support |
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Cardiology |
| Qualified D.M (Cardiology) or equivalent Degree (Round the
clock) |
| Well equipped ICCU & ICU facilities |
| Cathlab facility |
| Support Services of Physician/Pediatrician |
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Cardio-thoracic surgery |
| Qualified CT Surgeon (M.ch or equivalent) |
| CT theatre with Heart Lung machine, IABP |
| Cathlab facility |
| Cardiologist support |
| ICCU |
| Well equipped CT-ICU |
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Neurology |
| Qualified Neurologist (DM or equivalent) |
| EEG, ENMG, Angio CT facility |
| Neuro ICU facility |
| Physician support |
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Neurosurgery |
| Qualified Neuro - Surgeon(M.Ch or equivalent) |
| Well Equipped Theatre with Operating Microscope |
| Post Operative ward and ICU facilities |
| Neuro ICU facility |
| Round the clock CT/MRI services |
| Support services of Neurologist/physician. |
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Nephrology |
| Qualified Nephrologist (DM or equivalent) |
| Heamodialysis facility
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| Well equipped ICU,AMC and Physician support |
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Urology |
| Qualified urologist (M.ch or equivalent) |
| Well equipped theatre
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| C-ARM facility |
| Availability of endoscopic equipment |
| ESWL (optional) Tie up allowed |
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Pediatric Surgery |
| Qualified Pediatric surgeon (M.ch or equivalent) |
| Well equipped theatre |
| Post Operative ward and ICU facilities |
| Neonatal and Pediatric ICU support |
| Pediatrician Support services |
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Medical Gastroenterology |
| Qualified specialist (DM or equivalent) |
| Endoscopic facilities |
| Well equipped AMC & ICU Facilities |
| Physician support services |
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Surgical Gastroenterology |
| Qualified Surgical Gastroenterologist or equivalent |
| Well Equipped Theatre |
| Endoscopic equipment |
| ICU, Post Operative ward and support services of General
Surgeon |
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Plastic Surgery |
| Qualified Plastic Surgeon (M.ch or equivalent) |
| Well Equipped Theatre with Operating Microscope |
| Post Operative ward, ICU and support services of General
Surgeon |
| Burns ward |
| Post-op rehabilitation / Physio therapy |
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Endocrinology |
| Qualified Endocrinologist (DM or Equivalent) |
| Well equipped AMC & ICU Facilities |
| Physician support |
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Pulmonology
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| Qualified Pulmonologist (M.D (chest diseases) or equivalent
or DTCD) |
| RICU with spirometry & Bronchoscopy
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| Well equipped AMC & ICU Facilities |
| Physician support |
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Rheumatology |
| Qualified Rheumatologist |
| Well equipped AMC & ICU Facilities |
| Physician and Orthopedic Support |
| Physiotherapy Support |
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* 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 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. |
 VI Other Services
under the scheme
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| Hospital should be in a position to provide following additional
benefit to the BPL beneficiaries related to identified systems: |
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Provide space and separate Mahatma Jyotirao Phule Jan Arogya Yojana counter/kiosk as per the design for Arogyamitras (Health Coordinators) in the main entrance/reception of the Hospital. |
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Provide Computer with networking (broadband with minimum 2 mbps speed dedicated for each computer /system or leased line), printer, scanner, bar code reader, digital camera, web cam, Mike Speaker and Stationary.
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Provide quality food free of cost for the patients as envisaged in the package rates either through in-house pantry or by making alternate arrangements like supplying from nearby canteen.
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Provide transport or bear the cost of transport charges (To & fro) incurred by the beneficiary and agrees to arrange the same at the time of discharge and obtain acknowledgment from the patient accordingly.
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Provision of separate MJPJAY OPD with networking computer with printer connection.
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Free diagnostic tests and medical treatment required for beneficiaries irrespective of surgery either in the ‘In-House’ or with ‘Tie-up’ facility.
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Provide round-the-clock services of a dedicated Medical Officer to work as Medical Coordinator (MCO) for the scheme and he will be responsible to the Society and the Insurer 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. The Insurer will provide CUG Connection to all MCOs. Atleast one in-house surgeon and or in-house physician (MD) shall be available for empanelment of Surgical and Medical packages respectively.
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Free follow-up consultation and distribution of follow-up medicines for 125 identified procedures for a period of one year after the patient is discharged from the hospital. For 10 days till the discharge the patient should be provided necessary medication free of cost. Follow up treatment shall be entirely cashless to the patient and will start on 11th day after discharge and will continue for one year from the first availed date. Free review of every patient treated is mandatory.
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Minimum one free Health Camp in village in a week for the screening of the BPL patient suffering from the identified ailments. Hospital may have a mobile team with diagnostic equipments and team of doctors as specified by the Society for this purpose. Villages shall be identified by the trust in consultation with district administration and communicated to the hospitals/insurance company. Hospital shall provide services of Medical Camp Coordinator (MCCO) for organization of health camps. The Hospital shall follow the camp policy of the Society. The Insurer will provide CUG Connection to all MCCOs.
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The hospital should not to refuse admission of MJPJAY patient in any specialty where it has consultants and infrastructure and is empanelled. A minimum of 25% of overall bed capacity and of beds in each specialty have to be made available to MJPJAY patients in network hospital.
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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-MJPJAY for select specialities and discouraging admission to MJPJAY beneficiaries the empanelment of the hospital is liable to be terminated.
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The Hospital should intimate the Society/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.
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The newly empanelled hospitals shall submit MOUs for all the phases and all the schemes proposed by MJPJAY Society.
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Any dispute arising of Empanelment Registration will be subject to arbitration as per Arbitration Act and subject to the jurisdiction of Maharashtra courts only.
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| Note: 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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Download User Manual for Empanelment Application
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Kindly use Internet explorer 8 or above to fill the application form
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