|
ELIGIBILITY CRITERIA FOR EMPANELMENT OF HOSPITALS
|
|
 INTRODUCTION: |
| Employees Health Scheme is intended to provide cashless treatment to all the State Government employees including the State Government pensioners, along with their dependent family members through a network of empanelled hospitals of Employees Health Scheme Health Care Trust, in lieu of the present medical reimbursement system under 'The State Integrated medical Attendance Rules, 1972 (APIMA Rules, 1972)'. The scheme will provide treatment in Network Hospitals for all the listed therapies |
| The identified Network Hospitals are required to implement all
Employees Health Scheme sponsored by Government of State. |
| 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 State established for indoor medical care and
treatment of disease and injuries and should be registered under State Allopathic
Medical Care Establishments Act and PNDT Act (Wherever Applicable) |
| 'DOCTOR' - Qualified Allopathic Doctor recognized
by Medical Council of India and registered with State 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 State 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 Trust/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 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. |
 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 Cochlear Implant Surgery with Auditory-Verbal Therapy: |
 |
Services of Qualified and Trained ENT Specialist in Cochlear Implant Surgery
and sufficient number of qualified Auditory Verbal Therapists. Equipment and
Infrastructure related to Cochlear Implant Surgery. (Please read detailed
guidelines)
|
 C.
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.
|
| D.
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 State Medical Council. It may be noted that
online information provided by the hospital is cross checked automatically
online with State 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 State
Medical Council before applying online. |
 V. 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 Employees Health Scheme counter/kiosk as per the design for Aarogyamithras (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 Employees Health Scheme 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 Employees Health Scheme Medical Coordinator (RAMCO) for the scheme and he will be responsible to the Trust 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 RAMCOs. 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 Trust 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 Employees Health Scheme medical Camp Coordinator (AMCCO) for organization of health camps. The Hospital shall follow the camp policy of the Trust. The Insurer will provide CUG Connection to all AMCCOs.
|
 |
The hospital should not to refuse admission of Employees Health Scheme 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 Employees Health Scheme 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-Employees Health Scheme for select specialities and discouraging admission to Employees Health Scheme 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.
|
 |
The newly empanelled hospitals shall submit MOUs for all the phases and all the schemes proposed by Employees Health Scheme Health Care Trust.
|
 |
Any dispute arising of Empanelment Registration will be subject to arbitration as per Arbitration Act and subject to the jurisdiction of State 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 Trust. |
|
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|
|
|
|
|
|
ELIGIBILITY CRITERIA FOR EMPANELMENT OF DENTAL HOSPITALS
|
| INTRODUCTION: |
| Employees Health Scheme is intended to provide cashless treatment to all the State Government employees including the State Government pensioners, along with their dependent family members through a network of empanelled hospitals of Employees Health Scheme Health Care Trust, in lieu of the present medical reimbursement system under 'The State Integrated medical Attendance Rules, 1972 (APIMA Rules, 1972)'. The scheme will provide treatment in Network Hospitals for all the listed therapies |
| The identified Network Hospitals are required to implement all
Employees Health Scheme sponsored by Government of State. |
| 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 State established for indoor medical care and
treatment of disease and injuries and should be registered under State Allopathic
Medical Care Establishments Act and PNDT Act (Wherever Applicable) |
| 'DOCTOR' - Qualified Allopathic Doctor recognized
by Medical Council of India and registered with State Medical Council. |
| I. Dental Hospital (NWH) Requirements: |
|
1. A Dental Hospital constitutes of 5 Dental chairs for treatment procedures and 2 beds in recovery room, if OT and post op services are in tie-up and 4 beds of OT and post op services are in house. Covering all OP & IP Dental procedures listed under EHF scheme.
|
|
2. Dental Hospital should be in suitable location with desirable parking place.
|
|
3. Hospital type should be mentioned. Govt. /Private(Dental Hospital). In addition, a Dental hospital shall have in-house or tie-up OT facilities as per the standard OT protocol, with Post-Operative care and Private &Semi privaterooms.
If Dental hospital is having in-house OT, Emergency services should be provided for 24hrs.
|
|
4. Mention the year of establishment of Dental Hospital. Minimum 1 year of establishment is mandatory with maintenance of performance records of 6 months.
|
|
5. Approximate Area required for Dental Hospital–2000 sft.
|
|
6. Dental Hospital should display respective hospital working timings on the display board outside the building.
Dental Hospital should display the Specialists Names, their contact numbers & their timings on the display board in the Hospital.
Dental Hospital should display Emergency telephone number which is available for 24 hours in case of Dental emergency cases & dental post-operative emergencies.
|
|
7. Dental Hospital should provide place for kiosk near reception.
|
|
8. The following Clear Documents should be submitted at the time of applying for Empanelment under EHS.(Clear Document means which is scanned properly with concerned authority signature,date and official seal visible on the computer screen.
|
|
II. Required Documents:
|
|
S.no
|
* Mandatory Documents
|
Issuing Authority
|
|
1.
|
Building plan approval
|
Municipal commissioner/ Executive officer Panchayat. (Document with signature, official seal & date to be submitted.)
|
|
2.
|
Standard architectural design
|
Municipal commissioner/ Executive officer Panchayat. (Document with signature, official seal & date to be submitted.)
|
|
3.
|
Fire Department Clearance certificate -
|
Fire Services Authority.(Document with signature, official seal & date to be submitted.)
|
|
4.
|
APMCE Registration
|
District Medical and Health Officer. (Document with signature, official seal & dateto be submitted.)
|
|
5.
|
Pharmacy License
|
Director Drug Control Administration (DCA). (Document with signature, official seal & dateto be submitted.)
|
|
6.
|
Pollution Control Board Certificate
|
Pollution Control Board. (Document with signature, official seal & dateto be submitted.)
|
|
7.
|
Bio safety measures as per standard norms
|
Pollution Control Board. (Document with signature, official seal & dateto be submitted.)
|
|
8.
|
Bio Medical wastage Disposal Certificate
|
Govt / Pvt Agency. (Document with signature, official seal & dateto be submitted.)
|
|
9.
|
Ambulance Registration Certificate
|
Regional Transport Authority. (Documentwith signature, official seal & dateto be submitted.)
|
|
10.
|
Ambulance Insurance Certificate
|
Insurance Company. (Document with signature, official seal & dateto be submitted.)
|
|
11.
|
Occupancy certificate (After 2009 mandatory)
|
Municipal commissioner/ Executive officer Panchayat. (Document with signature, official seal & date to be submitted.)
|
|
12.
|
Blood bank- own/tie-up with liesence number
|
DCA- Drug Control Administration. (Document with signature, official seal & dateto be submitted.)
|
|
III. Desirable Documents:
|
|
S.No
|
Desirable Documents
|
Issuing Authority
|
|
1.
|
License for Surgical spirit
|
Excise authority
|
|
|
IV. * Mandatory Requirementfor Infrastructure:
|
|
S.no
|
Infrastructure
|
Dental Hospital
|
Approx. Area in sft
|
|
1.
|
Dental chairs
|
5
|
750
|
|
2.
|
Bed strength
If OT is in tie up
|
2, (2 beds in tie up with OT providing hospital)
|
250
|
|
3.
|
If OT is in house
|
4 beds in house
|
400
|
|
4.
|
Reception/ office room
|
1
|
150
|
|
5.
|
Patient waiting area
|
1
|
350
|
|
6.
|
Pharmacy
|
1
|
100
|
|
7.
|
Acrylic Lab-In house
|
1
|
150
|
|
|
Ceramic lab tie up
|
1
|
|
|
8.
|
Dental Records room
|
1
|
75
|
|
9.
|
Dental stores
|
1
|
75
|
|
10.
|
Toilets (male and female)
|
2
|
25(each)
|
|
11.
|
Radiology (space / room) (IOPA)
|
1
|
50
|
|
|
Total area (approx.)
|
|
2000 sft
|
|
To maintain norms for EH Scheme, pharmacy in-house with 50 sft space and with provision of mandatory medicines useful for dentistry only is required.
|
|
|
V. In-house /Tie-upDocuments:
|
|
All the Tie-up documents should be submitted on Rs 100/- Bond paper
|
|
S.no
|
Infrastructure with Necessary equipment and manpower
|
Dental Hospital
|
|
1.
|
OT Services with private and semi-private rooms with availability of medical services, attached toilets. (If in-house theatre- should be as per standard OT protocols).
|
In-house/Tie-up
|
|
2.
|
Metal Ceramic Lab
|
In-house/Tie-up
|
|
3.
|
Diagnostic Lab
|
In-house/Tie-up
|
|
4.
|
Radiology (OPG & Other)
|
In-house/Tie-up
|
|
5.
|
Ambulance Services
|
In-house/Tie-up
|
|
6.
|
Biomedical waste disposal- Hire services for Annual maintenance
|
Tie-up
|
|
|
VI. Minimum Mandatory Dental Instruments:
|
|
S.no
|
Instruments
|
Dental hospital
|
|
1.
|
Diagnostic instruments
|
5 sets
|
|
2.
|
Ultrasonic scalars
|
3
|
|
3.
|
Hand scalars and curettes
|
5 sets
|
|
4.
|
Filling / Restorative instruments
|
5 sets
|
|
5.
|
Light cure unit
|
2
|
|
6.
|
SurgicalForceps and Elevators
|
3 sets
|
|
7.
|
Minor surgical instruments
|
1 set
|
|
8.
|
Pedodontic instruments
|
1 set
|
|
9.
|
Orthodontic instruments
|
1 set
|
|
10.
|
Prosthodontic instruments , equipment
|
2 sets
|
|
11.
|
Soft tissue laser and Bleaching machine-DESIRABLE
|
1
|
|
12.
|
Miscellaneous-cheek retractors ,tongue depressors, plastic aprons for patients etc.
|
5
|
|
|
VII. Manpower:
|
|
S.No
|
Personnel
|
Dental Hospital
|
Academic requirements
|
|
1.
|
Security guard
|
1
|
10th class
|
|
2.
|
Receptionist
|
1
|
Graduate
|
|
3.
|
Dental OP Hygienist
|
1
|
Qualified hygienist DCI Registered/Inter with 2 Years of Experience.
|
|
4.
|
Person for sterilization& to help in recovery room
|
1
|
Qualified GNM
|
|
5.
|
Dental Technician
|
1
|
Qualified Dental technician DCI Registered
|
|
6.
|
Staff for records
|
1
|
Graduate
|
|
7.
|
Qualified BDS doctors
|
3
|
BDS. State Dental Council Registered
|
|
8.
|
Qualified MDS doctor
|
1
|
MDS. State Dental Council Registered
|
|
9.
|
Oral and Maxillo-Facial Surgeon (OMFS)
|
1
Full time if OT is In-house/ On call if OT is Tie-up
|
MDS. State Dental Council Registered
|
|
10.
|
Allopathic Duty Medical Officer
|
1
(on call)
|
MBBS. State Medical Council Registered
|
|
11.
|
Radiologist (MDS - Oral Medicine &Radiology)
|
1
(On call)
|
MDS. State Dental Council Registered
|
|
12.
|
Anaesthetist
|
1
Anaesthetist is On call for dental
|
DA/MD State Medical Council Registered
|
|
|
|
hospitals with in-house OT facilities & postop.
|
|
|
|
VIII. MEDCO& roles:
|
|
1. A full time working doctor (BDS/MDS) of respective hospital may be assigned the role of MEDCO for that hospital for regular correspondence with AHCT.
|
|
2. Once registration done by Aarogyamithra, MEDCO facilitates the treatment by guiding the patient to the treating doctor.
|
|
3. MEDCO uploads preauthorization and claim documents and also updates pending remarks, expert opinions, etc.Takes care of Erroneous claims.
|
|
4. Raises CR for change in MEDCO request, changes in Bank Account etc.
|
|
5. Raises CR for up gradation of clinic to hospital and vice versa.
|
|
6. MEDCO to be present in the discharge photo along with the patient and Aarogyamithra. Takes care of patient discharge & follow up treatment in cases of In- Patient Dental Procedures.
|
|
7. Raises CR for CMS (Change Management System)-i.e. if wrong photo is uploaded or if theprocedure code needs to be changed in the preauthorization already raised, employee code changes etc.
|
|
8. Telephonic intimation for pre-auth approval in case of emergencies to be utilized.
|
|
IX. Reception/Office Room:
|
|
Should accommodate below listed equipment-
|
|
1. Telephone.
|
|
2. Fax Machine.
|
|
3. Computer with printer and scanner.
|
|
4. Biometric device.
|
|
5. Barcode reader.
|
|
6. Webcam.
|
|
7. Intercom.
|
|
8. Availability of Internet facility with 2 Mbps or more.
|
|
9. Chairs for office staff, patients and their attendants.
|
|
10. Display of Board showing details of services/tie-up hospitals details with contact number.
|
|
X. Miscellaneous:
|
|
1. Generator with 5 kv capacity for Dental Hospital and Generator with 15kv capacity for Dental Hospital with in-house OT facilities, Post-operative facilities and private & semi private rooms is required.
|
|
2. A/C should be provided as per the requirement of the hospital. (1.5 to 3 tons)
|
|
3. A/C should be provided in OT, Post-operative room and private rooms if are in-house.
|
|
4. Refrigerator.
|
|
5. Drinking water facility / Water cooler.
|
|
6. Tube lights.
|
|
7. Fans.
|
|
8. Wall clock.
|
|
9. Writing tables for Doctors.
|
|
10. Chairs for Doctors.
|
|
11. Chairs for Nurses and other staff.
|
|
12. Chairs for patients and their attendants in waiting room/area.
|
|
13. Wash basin for hand wash.
|
|
14. Wash area with sink for cleaning surgical instruments.
|
|
15. Foot operated dustbins.
|
|
XI. Sterilization Room:
|
|
1. Autoclave (front loaded or top loaded)
|
|
2. Hot water Sterilizer
|
|
3. Hot air Sterilizer/ Oven
|
|
4. Glass bead sterilizer
|
|
5. UV light chamber for storage of sterilized instruments.
|
|
XII. Dental Stores:
|
|
1. Dental impression material.
|
|
2. Dental stone / Plaster.
|
|
3. Self-cure & Heat- cure Acrylics (pink & tooth coloured).
|
|
4. Different types of Dental waxes.
|
|
5. Dental cements.
|
|
6. Glass- inomers.
|
|
7. Soft liner material.
|
|
8. Root canal treatment materials.
|
|
9. Light cure material.
|
|
10. Orthodontic material.
|
|
11. Bone graft material.
|
|
12. Implant materials.
|
|
13. Artificial teeth.
|
|
14. Miscellaneous- cotton, suture, etc..
|
|
15. Provide cub-boards for dental materials.
|
|
XIII. Radiology:
|
|
1. A separate room or partition with a lead screen to be used to avoid radiation hazards.
|
|
2. IOPA X-ray machine and RVG are to be in-house.
|
|
3. Lead apron, lead gloves and goggles to be used to avoid radiation.
|
|
4. X-ray view box.
|
|
5. Periodic verification of Dosimeter is required.
|
|
XIV.Recovery Room:
|
|
1. Provide 2 beds in Dental Hospital with Saline Stand, First-aid and Emergency drugs.
|
|
2. ProvideBP apparatus, Stethoscope, Surgical dressing table, Torch- light,KidneyTray and Oxygen.
|
|
3. Provide Nursing staff /GNM.
|
|
4. Provide writing table & chair for Doctor.
|
|
5. Provide chair for nursing staff.
|
|
6. Provide chair for patient’s attendants.
|
|
7. Provide Dado height of 1.2 mtrs
|
|
XV. Acrylic Lab (In-house):
|
|
Should be well ventilated lab with following minimal equipment.
|
|
1. Bunsen burner.
|
|
2. Articulator.
|
|
3. Lathe machine with all attachments.
|
|
4. Lab Micromotor with hand piece.
|
|
5. Hanging motor with hand piece.
|
|
7. Denture Trimming stones, burs& finishing and polishing tools.
|
|
8. Laboratory materials like Dental waxes, Model materials, Acrylic materials. etc.
|
|
XVI. Dental Record Room:
|
|
Should maintain
|
|
1. OP register.
|
|
2. Dental Treatment/ Procedure register.
|
|
3. Staff attendance register.
|
|
4. IP/ Surgery register. (in case of In-house theatre & Private/ semi-private rooms).
|
|
5. MLC case registers.
|
|
6. Provide racks and cub-boards to keep registers.
|
|
XVII. Operation Theatre:
|
|
1. Dental hospitals can have In- house OT or Tie up OT with recognized Hospital with well-establishedcausality, OT services and post-operativecare. (Standard OT protocol to be followed both in In-house OT or in Tie-up OT and 24hrs service should be provided).
|
|
2. If Dental Hospital has in-house operation theatre,OT should have minimum of 120 to 200 sft area.
|
|
3. OT should have A/C facility. |
|
4. OT should have doctor’s changing room, nurse’s changing room and scrub area. |
|
5. OT should have the following minimum equipment: |
|
S.No |
OT-EQUIPMENT |
QUANTITY |
|
1.
|
Operating Table
|
1
|
|
2.
|
Autoclave- Electrical with 2-bin capacity
|
1
|
|
3.
|
Shadow less lamp adjustable & mobile
|
1
|
|
4.
|
Suction Apparatus- Electrical
|
1
|
|
5.
|
Anaesthetics M/C (Boyles with Flotec)
|
1
|
|
6.
|
Pulse Oximeter
|
1
|
|
7.
|
Defibrillator
|
1
|
|
8.
|
OT lights- Shadow less in ceiling
|
1
|
|
9.
|
Automist ( OT Fumigator)
|
1
|
|
10.
|
Ventilator
|
1
|
|
11.
|
Laryngoscope
|
1
|
|
12.
|
Ambu resuscitation bag
|
1
|
|
13.
|
Stretcher with trolley
|
1
|
|
14.
|
Sterile surgical instruments and Linen in sterile bins
|
As per requirement
|
|
15.
|
Adequate supply of gases including Oxygen
|
As per requirement
|
|
16.
|
Emergency drugs
|
As per requirement
|
|
17.
|
I.V.stand& fluids
|
As per requirement
|
|
18.
|
Instruments trolly
|
As per requirement
|
|
19.
|
Bio waste Management bins
|
As per requirement
|
|
20.
|
Stethoscope & B.P.Apparatus
|
As per requirement
|
|
6. OT should have the following minimum manpower.
|
|
S.No
|
Personnel
|
OT
|
Academic requirements
|
|
1.
|
Maxillo- facial Surgeon
|
1
|
MDS- DCI recognised
|
|
2.
|
Asst.Surgeon
|
1
|
BDS/MDS- DCI recognised
|
|
3.
|
Anaesthetist on call
|
1
|
DA/MD- MCI recognised
|
|
4.
|
Duty doctor on call
|
1
|
MBBS- MCI recognised
|
|
5.
|
Theatre nurse
|
1
|
GNM/BSc nursing well trained
|
|
6.
|
Theatre boy
|
1
|
10th class.
|
|
7.
|
Sweeper
|
1
|
Class IV employee
|
|
7. If OT is in-house, Postoperative room with the following facilities should be available. Ventilator, Pulse Oximeter, BP Apparatus, I.V. stand, I.V. fluids, Emergency drugs.
|
|
8. One well trained staff nurse is required to recognise and manage post-operative complications.
|
|
9. If OT is tie-up, the Tie-up hospital should be within a radius of 5 km.
|
|
10. Tie-up hospital should have sufficient manpower and infrastructure as per requirement.
|
|
11. Tie-up hospital should have semi private and private rooms in sufficient number so as to facilitate the EHFS beneficiaries.
|
|
12. Private room with one bed and semiprivate roomwith 2 beds is minimum requirement with attached bathrooms.
|
|
13. Blood bank and Ambulance tie-upmay be with the tie-up Hospitalor Dental Hospital can have direct tie-up with blood bank and Ambulance services.
|
|
14. Preferably the tie-up hospital is empanelled with Aarogyasri. |
|
|
XIX. Metal Ceramic Lab (In-house/Tie-up):
|
|
1.Color coded dustbins to be used for different kinds of surgical/ non-surgical disposals.
|
|
2. Services &contract agreement should be renewed yearly.
|
|
XIX. Metal Ceramic Lab (In-house/Tie-up):
|
|
If In house following equipment are mandatory.
|
|
1. Ceramic furnace
|
|
2. Centrifugal casting machine/ Induction casting machine
|
|
3. Burnout furnace
|
|
4. Sand blaster
|
|
5. Vacuum mix vibrator
|
|
6. Semi adjustable articulator.
|
|
7. Ultra Sonic cleaner.
|
|
8. Metal & Ceramic materials.
|
|
9. Metal & Ceramic finishing & polishing materials etc.
|
|
XX. Dental Chair with Unit:
|
|
Dental chair with spittoon, halogen light, suction apparatus, aerator, micro motor, 3 way syringe and revolving stool for operator.
|
|
XXI. Dental Implants:
|
|
In-house and trained& qualified personnel is mandatory.(Qualified personnel are :MDS in Prosthodontics, MDS in Periodontology, MDS in Oral & Maxillo facial surgery or a BDS qualified doctor with one year Diploma Certificate in Oral Implantology from a recognized University with past experience of completed 20 cases.
|
|
Minimal Dental implant equipment required: |
|
1. Physiodispenser and Ratchet.
|
|
2. Surgical Implant Kit with accessories. |
|
3. Prosthodontic Implant kit with accessories.
|
|
4. Implants to be of any standard company with FDA specifications.
|
|
XXI Financial and Bank Details:
|
|
1. Provide constitution of clinic- Public / Private / Proprietary / Partnership.
|
|
2. Provide name of the authorized signatory of the Dental clinic. |
|
3. Provide Dental clinic PAN.
|
|
4. Provide name of the Bank of the Dental clinic.
|
|
5. Provide name of the Branch of the Bank.
|
|
6. Provide Branch code number.
|
|
7. Provide Bank account numberof the Dental clinic.
|
|
8. Provide IFSC code of the Branch of the Bank.
|
|
|
ELIGIBILITY CRITERIA FOR EMPANELMENT OF DENTAL CLINICS
|
| INTRODUCTION: |
| Employees Health Scheme is intended to provide cashless treatment to all the State Government employees including the State Government pensioners, along with their dependent family members through a network of empanelled hospitals of Employees Health Scheme Health Care Trust, in lieu of the present medical reimbursement system under 'The State Integrated medical Attendance Rules, 1972 (APIMA Rules, 1972)'. The scheme will provide treatment in Network Hospitals for all the listed therapies |
| The identified Network Hospitals are required to implement all
Employees Health Scheme sponsored by Government of State. |
| 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 State established for indoor medical care and
treatment of disease and injuries and should be registered under State Allopathic
Medical Care Establishments Act and PNDT Act (Wherever Applicable) |
| 'DOCTOR' - Qualified Allopathic Doctor recognized
by Medical Council of India and registered with State Medical Council. |
| I. Dental Clinic (NWH) Requirements: |
| 1. A Dental Clinic constitutes of 3 Dental chairs for treatment procedures and 1 bed in recovery room, covering all OP Dental procedures listed under EHF scheme. |
| 2. A Dental Clinic should be in suitable location with desirable parking place. |
| 3. Hospital type should be mentioned. Govt. /Private (Dental Clinic) |
| 4. Mention the year of establishment of Dental Clinic. Minimum 1 year of establishment is mandatory with maintenance of performance records. |
| 5. Approximate Area required for Dental Clinic –1000 sft. |
| 6. Dental Clinic should display respective clinic working timings on the display board outside the building.
Dental Clinic should also display Specialists Names, their contact numbers & their timings on the display board to address emergencies. |
| 7. Dental Clinic should provide place for kiosk near reception. |
| 8. The following Clear Documents should be submitted at the time of applying for Empanelment under EHS. (Clear Document means which is scanned properly with concerned authority signature, date and official seal visible on the computer screen). |
|
II. Required Documents:
|
|
S.No
|
Mandatory Documents
|
Issuing Authority
|
|
1.
|
Building plan approval
|
Municipal commissioner/ Executive officer Panchayat. (Document with signature, official seal & date to be submitted.)
|
|
2.
|
Standard architectural design
|
Municipal commissioner/ Executive officer Panchayat. (Document with signature, official seal & date to be submitted.)
|
|
3.
|
Fire Department Clearance certificate -
|
Fire Services Authority. (Document with signature, official seal & date to be submitted.)
|
|
4.
|
APMCE Registration
|
District Medical and Health Officer. (Document with signature, official seal & date to be submitted.)
|
|
5.
|
Pharmacy License
|
Director Drug Control Administration (DCA). (Document with signature, official seal & date to be submitted.)
|
|
6.
|
Pollution Control Board Certificate
|
Pollution Control Board. (Document with signature, official seal & date to be submitted.)
|
|
7.
|
Bio safety measures as per standard norms
|
Pollution Control Board. (Document with signature, official seal & date to be submitted.)
|
|
8.
|
Bio Medical wastage Disposal Certificate
|
Govt / Pvt Agency. (Document with signature, official seal & date to be submitted.)
|
|
9.
|
Ambulance Registration Certificate
|
Regional Transport Authority. (Document with signature, official seal & date to be submitted.)
|
|
10.
|
Ambulance Insurance Certificate
|
Insurance Company. (Document with signature, official seal & date to be submitted.)
|
|
11.
|
Occupancy certificate (After 2009 mandatory)
|
Municipal commissioner/ Executive officer Panchayat. (Document with signature, official seal & date to be submitted.)
|
|
12.
|
Blood bank- own/tie-up with liesence number
|
DCA- Drug Control Administration. (Document with signature, official seal & date to be submitted.)
|
|
III. Desirable Documents:
|
|
S.No
|
Desirable Documents
|
Issuing Authority
|
|
1.
|
License for Surgical spirit
|
Excise authority
|
|
|
IV. Mandatory Requirement for Infrastructure:
|
|
S.No
|
Infrastructure
|
Dental Clinic
|
Approx. Area in sft
|
|
1.
|
Dental chairs
|
3
|
360
|
|
2.
|
Beds in recovery room
|
1
|
60
|
|
3.
|
Reception/ office room
|
1
|
100
|
|
4.
|
Patient waiting area
|
1
|
150
|
|
5.
|
Pharmacy
|
1
|
50
|
|
6.
|
Acrylic Lab-In house
|
1
|
100
|
|
7.
|
Dental Records room
|
1
|
50
|
|
8.
|
Dental stores
|
1
|
50
|
|
9.
|
Radiology (space / room) for IOPA & RVG
|
1
|
50
|
|
10.
|
Toilets (male and female)
|
2
|
25 (each)
|
|
|
Total area (approx.)
|
|
1000sft
|
|
To maintain norms for EHF Scheme, pharmacy in-house with 50 sft space and with provision of mandatory medicines useful for dentistry only is required.
|
|
|
V. In-house /Tie-up Documents:
|
|
S.No
|
Infrastructure with Necessary equipment and manpower
|
Dental Clinic
|
|
1.
|
Metal Ceramic Lab
|
In-house/Tie-up
|
|
2.
|
Diagnostic Lab
|
In-house/Tie-up
|
|
3.
|
Radiology (OPG & Other)
|
In-house/Tie-up
|
|
4.
|
Ambulance Services
|
In-house/Tie-up
|
|
5.
|
Biomedical waste disposal- Hire services for Annual maintenance
|
In-house/Tie-up
|
|
|
VI. Minimum Mandatory Dental Instruments:
|
|
S.No
|
Instruments
|
Dental clinic
|
|
1.
|
Diagnostic instruments
|
3 sets
|
|
2.
|
Ultrasonic scalars
|
2
|
|
3.
|
Hand scalars and curettes
|
3 sets
|
|
4.
|
Filling / Restorative instruments
|
3 sets
|
|
5.
|
Light cure unit
|
1
|
|
6.
|
Surgical Forceps and Elevators
|
2 sets
|
|
7.
|
Minor surgical instruments
|
1 set
|
|
8.
|
Pedodontic instruments
|
1 set
|
|
9.
|
Orthodontic instruments
|
1 set
|
|
10.
|
Prosthodontic instruments, equipment
|
1 set
|
|
11.
|
Soft tissue laser and Bleaching machine-DESIRABLE
|
1
|
|
12.
|
Miscellaneous-cheek retractor ,tongue depressors, plastic aprons for patients etc.
|
3
|
|
|
VII. Manpower:
|
|
S.No
|
Personnel
|
Dental Clinic
|
Academic requirements
|
|
1.
|
Security guard
|
1
|
10th class
|
|
2.
|
Receptionist
|
1
|
Graduate
|
|
3.
|
Dental OP Hygienist
|
1
|
Qualified hygienist, DCI Registered/Inter with 2 Years of Experience.
|
|
4.
|
Person for sterilization & to help in recovery room
|
1
|
Qualified GNM
|
|
5.
|
Dental Technician
|
1
|
Qualified Dental technician DCI Registered
|
|
6.
|
Staff for records
|
1
|
Graduate
|
|
7.
|
Qualified BDS doctors
|
2
|
BDS. State Dental Council Registered
|
|
8.
|
Qualified MDS doctor
|
1
|
MDS. State Dental Council Registered
|
|
9.
|
Oral and Maxillo-Facial Surgeon (OMFS)
|
1
(On call)
|
MDS. State Dental Council Registered
|
|
10.
|
Allopathic Duty Medical Officer
|
1
(on call)
|
MBBS. State Medical Council Registered
|
|
|
VIII. MEDCO & roles:
|
|
1. A full time working doctor (BDS/MDS) of respective hospital may be assigned the role of MEDCO for that hospital for regular correspondence with AHCT.
|
|
2. Once registration done by Aarogyamithra, MEDCO facilitates the treatment by guiding the patient to the treating doctor.
|
|
3. MEDCO uploads preauthorization, claim documents, also updates pending remarks and expert opinions, etc. Takes care of Erroneous claims.
|
|
4. Raises CR for change in MEDCO request, changes in Bank Account etc.
|
|
5. Up gradation of clinic to hospital and vice versa.
|
|
6. MEDCO to be present in the discharge photo along with the patient and Aarogyamithra.
|
|
7. Raises CR for CMS (Change Management System)-i.e. if wrong photo is uploaded or if the procedure code needs to be changed in the preauthorization already raised, employee code changes etc.
|
|
8. Telephonic intimation for pre-auth approval in case of emergencies.
|
|
VIII. MEDCO & roles:
|
|
Should accommodate below listed equipment-
|
|
1. Telephone.
|
|
2. Fax Machine.
|
|
3. Computer with printer and scanner.
|
|
4. Biometric device.
|
|
5. Barcode reader.
|
|
6. Webcam.
|
|
7. Intercom.
|
|
8. Availability of Internet facility with 2 Mbps or more.
|
|
9. Chairs for office staff, patients and their attendants.
|
|
X. Miscellaneous:
|
|
1. Generator of 2.5 to 3 kv capacity for Dental Clinic.
|
|
2. A/C with 1.5 tons to be available.
|
|
3. Refrigerator.
|
|
4. Drinking water facility / Water cooler.
|
|
5. Tube lights.
|
|
6. Fans.
|
|
7. Wall clock.
|
|
8. Writing tables for Doctors.
|
|
9. Chairs for Doctors.
|
|
10. Chairs for Nurses and other staff.
|
|
11. Chairs for patients and their attendants in waiting room/area.
|
|
12. Wash basin for hand wash.
|
|
13. Wash area with sink for cleaning surgical instruments.
|
|
14. Foot operated dustbins.
|
|
XI. Sterilization Room
|
|
1. Autoclave (front loaded or top loaded).
|
|
2. Hot water Sterilizer.
|
|
3. Hot air Sterilizer/ Oven.
|
|
4. Glass bead sterilizer.
|
|
5. UV light chamber for storage of sterilized instruments.
|
|
XII. Dental Stores:
|
|
All essential dental materials for different dental procedures should be available.
|
|
1. Dental impression material.
|
|
2. Dental stone / Plaster.
|
|
3. Self-cure & Heat- cure Acrylics (pink & tooth coloured).
|
|
4. Different types of Dental waxes.
|
|
5. Dental cements.
|
|
6. Glass- inomers.
|
|
7. Soft liner material.
|
|
8. Root canal treatment materials.
|
|
9. Light cure material.
|
|
10. Orthodontic material.
|
|
11. Bone graft material.
|
|
12. Implant materials.
|
|
13. Artificial teeth.
|
|
14. Miscellaneous- cotton, suture, etc..
|
|
15. Provide cub-boards for dental materials.
|
|
XIII. Radiology:
|
|
1. A separate room or partition with a lead screen to be used to avoid radiation hazards.
|
|
2. IOPA X-ray machine and RVG are to be in-house.
|
|
3. Lead apron, lead gloves and goggles to be used to avoid radiation.
|
|
4. X-ray view box.
|
|
5. Periodic verification of Dosimeter is required.
|
|
XIV. Recovery Room:
|
|
|
|
1. Provide 1 bed for Dental Clinic with I.V. Stand, First-aid and Emergency drugs.
|
|
2. Provide BP apparatus, Stethoscope, Surgical dressing table, Torch- light, Kidney Tray and Oxygen.
|
|
3. Provide Nursing staff/GNM.
|
|
4. Provide writing table & chair for Doctor.
|
|
5. Provide chair for nursing staff.
|
|
6. Provide chair for patient’s attendants.
|
|
7. Provide Dado height of 1.2 mtrs
|
|
XV. Acrylic Lab (In-house):
|
|
Should be well ventilated lab with following minimal equipment.
|
|
1. Bunsen burner.
|
|
2. Articulator.
|
|
3. Lathe machine with all attachments.
|
|
4. Lab Micromotor with hand piece.
|
|
5. Hanging motor with hand piece.
|
|
6. Denture curing flask and press.
|
|
7. Denture Trimming stones, burs & finishing and polishing tools.
|
|
8. Laboratory materials like Dental waxes, Model materials, Acrylic materials. etc.
|
|
XVI. Dental Record Room:
|
|
Should maintain
|
|
1. OP registers.
|
|
2. Dental Treatment/ Procedure register.
|
|
3. Staff attendance register.
|
|
4. MLC case registers.
|
|
5. Provide racks and cub-boards to keep registers.
|
|
XVII. Biomedical Waste Management:
|
|
1. Colour coded dustbins to be used for different kinds of surgical/ non-surgical disposals.
|
|
2. Services & Contract Agreement should be renewed yearly.
|
|
XVIII. Metal Ceramic Lab (In-house/Tie-up):
In
|
|
1. Ceramic furnace.
|
|
2. Centrifugal casting machine/ Induction casting machine.
|
|
3. Burnout furnace.
|
|
4. Sand blaster.
|
|
5. Vacuum mix vibrator.
|
|
6. Semi adjustable articulator .
|
|
7. Ultra Sonic cleaner
|
|
8. Metal &Ceramic materials.
|
|
9. Metal & Ceramic finishing & polishing materials etc.
|
|
XIX. Dental Chair with Unit:
|
|
Dental chair with spittoon, halogen light, suction apparatus, aerator, micro motor, 3 way syringe and revolving stool for operator.
|
|
XX. Dental Implants:
|
|
In-house and trained & qualified personnel is mandatory. (Qualified personnel are : MDS in Prosthodontics, MDS in Periodontology, MDS in Oral & Maxillo facial surgery or a BDS qualified doctor with one year Diploma Certificate in Oral Implantology from a recognized University with past experience of completed 20 cases.
|
|
Minimal Dental implant equipment required:
|
|
1. Physiodispenser and Ratchet.
|
|
2. Surgical Implant Kit with accessories.
|
|
3. Prosthodontic Implant kit with accessories.
|
|
4. Implants to be of any standard company with FDA specifications.
|
|
XXI Financial and Bank Details:
|
|
1. Provide constitution of clinic- Public / Private / Proprietary / Partnership.
|
|
2. Provide name of the authorized signatory of the Dental clinic.
|
|
3. Provide Dental clinic PAN.
|
|
4. Provide name of the Bank of the Dental clinic.
|
|
5. Provide name of the Branch of the Bank.
|
|
6. Provide Branch code number.
|
|
7. Provide Bank account number of the Dental clinic.
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8. Provide IFSC code of the Branch of the Bank.
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