Rajiv Gandhi Jeevandayee Arogya Yojana

ELIGIBILITY CRITERIA FOR EMPANELLMENT OF HOSPITALS

  INTRODUCTION:
Government of Maharastra is implementing Rajiv Gandhi Jeevandayee 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.
The identified Network Hospitals are required to implement all RGJAY 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:
  A. REQUIREMENTS
I Definition
HOSPITAL / NURSING HOME: Means any functioning speciality hospital in Maharastra established for indoor medical care and treatment of disease and injuries and should be registered under Maharashtra Allopathic Medical Care Establishments Act and PNDT Act (Wherever Applicable)
‘DOCTOR’ - Qualified Allopathic Doctor recognized by Medical Council of India and registered with Maharastra Medical Council.
  II Infrastructure and Expertise (General):
The hospital should have the following Expertise & Infrastructure as per guidelines:
Minimum 50 inpatient medical beds with adequate spacing of 60Sq.feet for each bed and supporting staff as per norms. Atleast one in-house surgeon and or in-house physician (MD) shall be available for empanelment of Surgical and Medical packages respectively.
All the doctors working in the hospitals whether fulltime or part-time should be registered under Maharashtra Medical Council. The hospital should have at least minimum of 3 MBBS doctors as 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
Round- the-clock, availability of Duty Doctors & Paramedic staff 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.
Casualty should be equipped with Monitors, Defibrillator, Crash Cart, Resuscitation equipment, Oxygen and Suction facility and with attached toilet facility. Fully equipped Operation Theatre along with required equipments as mentioned in the specific requirements for each Specialty.
Post-op ward with adequate number of Monitors, Ventilators and other required facilities. ICU facility with Monitors, Ventilators, Oxygen facility, Suction facility, Defibrillator, and required other facilities & requisite staff.
Separate male and female wards with toilet and other basic amenities. Round-the-clock availability of specialists in the concerned specialties having sufficient experience and availability of specialists in support fields with short notice.
Round-the-clock advanced diagnostic facilities either ‘In-House’ or with ‘Tie-up’ with a nearby Diagnostic Center. Round-the-clock Blood Bank facilities either ‘In-House’ or with ‘Tie-up’ with a nearby Blood Bank.
Round-the-clock Physiotherapy centre facilities either ‘In-House’ or with ‘Tie-up’ with a nearby Physiotherapy Center, wherever it is applicable. Round-the-clock own Ambulance facilities.
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. 24 Hrs In-house pharmacy
Safe drinking water facilities. Generator facility with required capacity suitable to the bed strength of the hospital should be installed.
Bio Medical waste management facility available Fire Fighting system available.
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)
  A. For Empanelment of Cancer Therapy
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.
Note: A combination of both professional and the equipment is essential.
  B. For Empanelment of Poly Trauma
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.
  • Shall have dedicated round the clock Emergency theatre, Surgical ICU, Post-Op Setup with qualified staff.
  • Shall be able to provide necessary cashless diagnostic support round the clock including specialized investigations such as CT, MRI, emergency biochemical investigations.
  C. For Empanelment of Prostheses (Artificial limbs)
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).
  • Shall also facilitate free replacement of leather parts and ensure total replacement of Prosthesis in case of damage during guarantee period of 3 years
  IV Specialty wise specific requirements
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
Orthopedic Surgery
Qualified M.S Ortho. or D.Ortho or DNB (Ortho.)
Well equipped theatre with C-Arm facility
Trained paramedics
Well equipped Post Operative ward and ICU facilities
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
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
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
General Medicine
Qualified M.D (General Medicine) or DNB (General Medicine)
Well equipped AMC & ICU Facilities
Pediatrics
Qualified M.D (Paed.) or D.C.H or DNB (Paed.)
Well equipped PICU/NICU
Dermatology
Qualified M.D (Derm.) or M.D (DVL) or D.D.V.L or DNB (DVL)
Well equipped AMC with Physician support
Cardiology
Qualified D.M (Cardiology) or equivalent Degree (Round the clock)
Well equipped ICCU & ICU facilities
Cathlab facility
Support Services of Physician/Pediatrician
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
Neurology
Qualified Neurologist (DM or equivalent)
EEG, ENMG, Angio CT facility
Neuro ICU facility
Physician support
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.
Nephrology
Qualified Nephrologist (DM or equivalent)
Heamodialysis facility
Well equipped ICU,AMC and Physician support
Urology
Qualified urologist (M.ch or equivalent)
Well equipped theatre
C-ARM facility
Availability of endoscopic equipment
ESWL (optional) Tie up allowed
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
Medical Gastroenterology
Qualified specialist (DM or equivalent)
Endoscopic facilities
Well equipped AMC & ICU Facilities
Physician support services
Surgical Gastroenterology
Qualified Surgical Gastroenterologist or equivalent
Well Equipped Theatre
Endoscopic equipment
ICU, Post Operative ward and support services of General Surgeon
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
Endocrinology
Qualified Endocrinologist (DM or Equivalent)
Well equipped AMC & ICU Facilities
Physician support
Pulmonology
Qualified Pulmonologist (M.D (chest diseases) or equivalent or DTCD)
RICU with spirometry & Bronchoscopy
Well equipped AMC & ICU Facilities
Physician support
Rheumatology
Qualified Rheumatologist
Well equipped AMC & ICU Facilities
Physician and Orthopedic Support
Physiotherapy Support
* 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
Hospital should be in a position to provide following additional benefit to the BPL beneficiaries related to identified systems:
Provide space and separate Rajiv Gandhi Jeevandayee Arogya Yojana counter/kiosk as per the design for Arogyamitras (Health Coordinators) in the main entrance/reception of the Hospital.
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.
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.
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.
Provision of separate RGJAY OPD with networking computer with printer connection.
Free diagnostic tests and medical treatment required for beneficiaries irrespective of surgery either in the ‘In-House’ or with ‘Tie-up’ facility.
Provide round-the-clock services of a dedicated Medical Officer to work as Rajiv  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.
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.
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.
The hospital should not to refuse admission of RGJAY 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 RGJAY patients in network hospital.
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-RGJAY for select specialities and discouraging admission to RGJAY beneficiaries the empanelment of the hospital is liable to be terminated.
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. 
The newly empanelled hospitals shall submit MOUs for all the phases and all the schemes proposed by RGJAY Society.
Any dispute arising of Empanelment Registration will be subject to arbitration as per Arbitration Act and subject to the jurisdiction of Maharashtra courts only.
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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