Corona

NOTIFICATION Public I Icalth Dcpartmcnt G.'l'. Hospital Compound, 10th Floor, New Mantralaya, Mumbai 400 001 Date :- I'r June, 2021 References:

1) The Epidemic Diseases, 1897.

2) The Disastcr Management Act, 2005.

3) Indian Penal Code, 1860.

4) 'l'he Maharashtra Essential services Maintenance (Amcndmcnt) Act, 201 1.

5) The Maharashtra Nursing Home (Amcndment) Ac1, 2006.

6) Bombay Public Trusts Act, 1950 (for short B.P.'l'Act).

7) Public Ilealth Department Notification No. CORONA- 2020 / C.R.97 / Aro- 5, datcd 3 0.04.2020 and 2 I .0 5.2020.

8) Public I Iealth Department Notification No. CORONA-

20201C.R.97//\ro-5, dated 31.08.2020, 30.11.2020, 15.12.2020 and

27.02.2021.

9) Order dated 23.10.2020 passed by IIon.IIigh Court, Mumbai bcnch Nagpur in WP No.1936/2020.

No.CORONA-20201 C.R.97l Arogya-S:- Whereas the State Govemment is satisfied that the State of Maharashtra is threatened with the spread of Covid 19 epidemic already declared as a pandemic by World Health Organization and accordingly in exercise of the powers conferred as per the enabling provisions of all above Acts, has issued notifications referred in Sr.No.7 and 8 above.

Whereas the public Charitable Trusts registered under the provisions of the Bombay Public Trusts Act, 1950 (for short'B.P.T. Act') which are running Charitable I{ospitals, including nursing homes or maternity homes, (1ヽ1,se応 nヽJ`h“lkODesktop― SNotlrlcatlon 01 06 2021 docx dispensaries or any other center for medical relief and whose annual expenditure exceeds Rs.5 Lacs are " State aided public trust " within the meaning of clause 4 of section 4 1AA;

Whereas The public Charitable Trust covered by aforesaid paragraph are under legal obligation to reserve and earmark 10% of the total number of operational beds for indigent patients and provide medical treatment to the indigent patients free of cost and reserve and earmark l0o/o of the total number of operational beds at concessional rate to the weaker section patients as per the provisions of section 41 AA of the B.P.T. Act;

Whereas a large number of persons including those affected by Covid- 19 are in need of treatment and various Hospitals, Nursing Homes, Dispensaries (hereinafter referred as Healthcare Providers) registered under Bombay Nursing Home (Amendment) Act, 2006 are treating such patients;

Whereas many Healthcare Providers in Mumbai, l'hane, Navi Mumbai, Panvel and Pune have specific agreements/ understanding with General Insurance Public Sector Associations (GIPSA) as a member of Preferred Private Network (PPN) regarding rates of various treatment packages and somc I lealthcare Providers in Mumbai are not part of GIPSA- PPN;

Whereas many Healthcare Providers situated in State of Maharashtra are not part of GIPSA- PPN and have their own specific agreements/ understanding with various Third Party Administrators (TPA) regarding rates ol various treatment packages and each Healthcare Provider may have different rates for same treatment packages among various TPAs operating in that Healthcare Provider;

Whereas some hospitals in the State of Maharashtra are neither part of GIPSA-PPN nor having agreements/ understanding with any TPA;

CAl時eに nヽl疇 h Falkeヽ Desktop― SNo・ ・ Ca.o■ 01 06 2021 doc■ Whereas expenses towards treatment of persons insured for IRDA approved healthcare products treated in GIPSA-PPN or network of hospitals empanelled by various TPAs at specific package rates agreed by them are bome by the insurer. However the persons who are not covered by any health insurance product or who have exhausted their health insurance cover are being charged exorbitantly causing hardships to public in general during the pandemic situation.

Whereas section 2 (a) (iii) of the Maharashtra Essential Services Maintenance Act, 2005 defines any service connected with the maintenance of Public Health and Sanitation including hospitals and Dispensaries as Essential Service; whereas large number grievances regarding exorbitant amount of money being charged by the Healthcare Providers registered under Bombay Nursing Home (Amendment) Act, 2006 causing hardship to the public in general during the COVID-l9 pandemic were received; & State Govemment earlier had issued notifications at serial No. 7 referred above.

Hencc, Now Govemment of Maharashtra has decided to amend the notifi cation No. CORONA -2020 I C.R.97 lAro-5 Dated 3 1 .08.2020, 30.1 I .2OZO and, 27.02.2021 and issue the addendum and modification to the extent mentioned below and has decided to extend operations of these notifications till 31.08.2021. Ihis notification shall be applicable for Covid-19 and suspected Covid- 1 9 patients.

Therefore, in exercise of the powers conferred as per the cnabling provisions of all the above referred Acts, to redress the grievances regarding exorbitant amount of money charged by Healthcare providers from the patients who are not covered by any health insurance product or any bilateral agreement / MOU between any hospital and private corporate group and who \Y CAUsettbil‐ h falkeヽ D“ ktopヽJ瞑ヽ■ sNOtinca“ on ol o6 2121 dotx have exhausted their such health insurance cover, all the Healthcare Providers functioning in the State of Maharashtra are hereby directed that:

The Charitable Trusts registered under the provisions of the B.P.T.

Act which are running Charitable Hospitals, including nursing home or matemity home, dispensaries or any other center for medical relief shall make all possible efforts to discharge their obligations as per provisions of section 41AA of the B'P.T. Act before applying any charges to any eligible patient' I Iealthcare providers shall make all attempts to increase their bed capacity fsubject to norms prescribed in The Maharashtra Nursing IIome (Amendment) Act 2006] to accommodate maximum number of patients.

(a) Throughout the Maharashtra, total operational bed capacity for treatment of Covid-l9/suspected Covid-19 will be regulated by rates prescribed below. This applies to Isolation beds. That means 80% of Isolation beds available with any Healthcare provider under this notification should be regulated by State Govt. /District Collectors/\4unicipal Commissioners' Healthcare Providers may charge their rack rates to the remaining 20% beds.

(b) In the Area of Municipal Corporation of Greater Mumbai 80% of isolation beds (Covid Beds), provided number of available isolation beds for Covid patients as on 31.08.2020 does not get reduced, available with any health care provider under this notification should be regulated by Commissioner, MCGM/District Collector in Mumbai. Health care provider may charge their rack rates to remaining 20 o/o of isolation beds in the area of MCGM only.

う ４ Cltrsers\ 16h.f.lk.\D6ltop\.,nltrl 5\Noiiric.aioD 01,06.202l.docr Patients belonging to both categories (80% and 20o/o) can take treatment in NICU, PICU, daycare and hemodialysis at the respective applicable rates on first come first serve basis For Covid Patients treated at any of the Hospitals/lrlursing homes/Clinics covered under this notification across Maharashtra, rates shall not be more than rates prescribed in Annexure A.

There shall be no difference in the quality of treatment being meted out to patients treated against 80% oftotal beds or 20%obeds.

The Healthcare Providers shall display at a prominent place number of permitted beds [permitted as per The Maharashtra Nursing Home (Amendment) Act 20061, operational beds status of availability of beds as per section 4lAA of the B.P.T. Act, 80:20 division of beds.

i.e. numbers of beds regulated under this notification against which patients as referred by respective District Collectors and Municipal Commissioner would be admitted as well as number of unregulated beds and status of occupancy against all beds in regulated (80%), as the case may be and non-regulated (20oh) category.

Healthcare Providers shall display at prominent place the details of rates applicable for Covid- 19/suspected Covid- 19 patients as per the Annexure A of this notification. It is the duty of the concemed Healthcare Provider to explain to the patient/ relatives of the patient details of all types of charges. The Healthcare Provider shall provide this information to Competent Authorities (respective Municipal Commissioner/ District Collector) at a frequency prescribed by them. Municipal Commissioners and District Collectors are advised to develop an online digital platform to update and disseminate occupancy position of beds for Covid patients.

3) 4) 5) 6) 7) C:ヽUse● nヽil“ h Fallい 06ktopl― SNotl● catiom 01 06 2021 docx 8) The package rate fixed in this Notification for charging patients is inclusive of Doctors' fees & the Healthcare Provider concemed has the inclusive of Doctors fees & the concerned healthcare provider has right to call such of its visiting Doctors to render the required services & pay such amount as it decides for the said services out of the package amount so charged. Any denial by the doctors will attract penal action under various Statutes referred to in this Notification including cancellation of MMC Registration.

9) Nursing and other support staff working in the Healthcare Provider shall give full support and extend wholehearted cooperation for the smooth functioning of the Healthcare Provider which comes under Maharashtra Essential Services Maintenance Act, 2005. Any group or union activities against the smooth function of the Healthcare Provider will attract penal provisions under the said Act.

10) For Covid patients rates prescribed as per annexure A shall be applicable. The rates in Annexure- A shall apply to Covid positive or suspected Covid positive patients referred by competent authorities against regulated beds (80% of total Isolation beds) in each of the healthcare provider.

I l) All hospitals shall give pre-audited bill to the patient. If at a later date it is found that extra charges have been levied then excess amount shall be reimbursed to the patient. Respective District Collectors and Municipal Commissioner shall appoint auditors in such Covid hospitals/facilities to ensure issuance of pre-audited bills to each and every patient and its relatives.

l2) Any hospital found violating any provision of this notification shall be deemed to have committed an offence and shall be liable for cancellation of registration of nursing home and offence under Indian Penal Code shall be registered.

Cハtse応 nヽilesh fni“ ODsktop-5NC・ 6●atloo 01 06 2021 docI 13) The rates prescribed in Annexure A are applicable to 80% of total number of beds available in various bed categories for treatment of Covid-19 patients or suspected Covid-I9 patients. The intention of all previous notifications in this regard was to apply prescribed rate to 80o/o of available beds. However, certain interpretations were drawn to deprive beneficiaries from their intended legitimate benefits. To bring abundant clarity within the provisions of all previous notifications in this regard, it is clarified that prescribed rates as per Annexure A are applicable to 80% of total number of beds available for treating of Covid-19 patients or suspected Covid- 19 patients, irrespective whether such patients are referred by competent authorities or not.

l4) Rates will be applicable fiom the date of issue of notification.

Therefore for implementation of the above provisions, the competent authority at the State level shall be the Chief Executive Offrcer, State Health Assurance Society, Public Health Department, The competent authority at District Level (for areas excluding Municipal Corporations) shall be District Collector and in Municipal Corporation areas the concemed Municipal Commissioner shall be competent authority to take appropriate action as provided in The Epidemic Diseases Act, 1897, The Disaster Management Act, 2005, The Maharashtra Essential Service Maintenance (Amendment) Act 2011, The Murnbai Nursing Home (Amendment) Act 2006, The Bombay Nursing Home Registration (Amendment) Act, 2006 and The Bombay Public Trusts Act, 1950 for any violation of these directions.

This notification shall come in effect immediately and would remain in operation till 3 1 .08.2021 .

C:ヽモIse応 nヽilesh falkelDesktop-5ヽ NotlrlentiOn o1 06 2021 docx All private hospitals, nursing homes and health care providers shall act accordingly.

By order and in the name of Govemor of Maharashtra 。.鞣 eょcttan Principal Secrctary, Governmcnt of Maharashtra Copy to :

I ) Principal Secretary to Hon'ble Govemor, Rajbhavan, Mumbai.

2) Addl. Chief Sccretary to llon'ble Chief Minister, Mantralaya, Mumbai.

3) Principal Sccrctary to I{on'blc Deputy Chief Minister, Mantralaya, Mumbai.

4) llon'blc Ministcr (Health & I'-amily Welfare), Mantralaya, Mumbai.

5) I{on'ble Minister of Statc (llealth & Family Welfare), Mantralaya, Mumbai.

6) Chief Secretary, Mantralaya, Mumbai.

7) Additional Chiel Secretary/ Principal Secretary/ Secretary, Mantralaya, Mumbai' (Au) 8) Secretary, Maharashtra Legislature Sccretariat, Vidhan Bhavan, Mumbai.

9) Commissioncr, Health Scrvices Cum Mission Director, NHM, Mumbai l0) Charity Commissioner, M.S., Mumbai I l) Chief lJxecutive Officer, State Health Assurance Society, Worli, Mumbai l2) All l)ivisional Commissioners l3) All Districl Collectors l4) All Municipal Commissioners I 5) All Chief Iixecutive Offtcers, Zilla Parishad l6) Director, Health Services- VII, Mumbai/ Pune.

l7) Additional Director, Heahh Services (All) l8) Joint Dircctor, Ilealth Services (All) l9) Deputy Directors, Health Services (All) 20) Civil Surgeons (All) 2l ) District I{ealth Officers (All) 22) District Malaria Officers (All) 23) Deputy Secretary to Chief Secretary, Mantralaya, Mumbai 24) All joint/ Deputy Secretary, Under Secretary, Section Officers, Public Ilealth Department 25) President, India Medical Association 26) PA to Principal Secretary, Public Flealth Department 27) Sclcct Iilc: Arogya - 5.

CAl嘔e内 nヽllesh f3[ke｀ 飲sklop― Nヽo“nca● 0■ o■ 06 2021 dotx Annexure A Maximum rates which can be charged to Covid patients (Applicable throught Maharashtra for all health care Providersl Packages Rate in INR per dav Inclusions Exclusions Charges for Routine ward + Isolation A Class Cities 4000 B Class Cities 3000 C Class Cities 2400 This includes - Monitoring & investigations like CBC, Urine Routine, HIV Spot Anti HCV, Hbs Ag, Serum Creatinine, USG, 2D ECHO, X Ray, ECG, Drugs, Oxygen charges Consultations Bed charges Nursing charges Meals Procedures like Ryles tube insertion, urinary tract Catheterizatton Does not include- 1) PPE- (Hospitals can charge Rs.600/― (maximum) per patient per day for stay in ward and Rs.1200 /- maximum per patient per day for stay in ICU.

Any charge more than this towards PPE needs to be justified 2l Interventional Procedures like but not limited to, Central Line insertion, Chemoport Insertion, bronchoscopic procedures, biopsies, ascetic/ pleural tapping, etc, which may be charges at the rack rate as on 3l"t Dec 2019.

3) COVID testing - to be done as per actual cost as per applicable GR.

4) High end drugs like immunoglobulins, Meropenem, Parenteral Nutrition, Remdesivir, Flavipiravir, Tocilizumab, etc. - sherll not be charged more thanlo% markup on net procurement cost incurred. (as per actual quantity used for the concern patient) 5) High end investigations like CT scan, MRI, PET scan or any lab investigation not included in the previous column- to be charged at rack rates of hospital as on 3lst Dec 2OL9.

Charges for ICU without ventilator + Isolation A Class Cities 7500 B Class Citics 5500 C Class Cities 4500 Charges for ICU with ventilator+ Isolation Class Citics 9000 Class Citics 6700 Class Citics 5400 A B C 'Classiflcation of Citics(A Class Citics,B Class Cities and C Class Cities/areas)as pcr pagc 2 of anneXurc A.

斃 C: \Users\nilesh.falke\Desktop\urfrrl 5\3 1.O5.2O2 I UD-q4qt gTi.6oc, Page I of Annexure A Classilication of Cities Classification Name of the Group of Cities Areas incoroorated in the sroup A Class cities/Areas Mumbai １ ２ ３ ４ ５ ６ ７ ８ ９ Brihanmumbai MCGM Mira Bhayander MNC Thane MNC Navi Mumbai MNC Kalyan Dombivali MNC Ulhasnagar MNC Ambernath MC Kulgaon Badlapur MC Panvel MC Punc １ ２ ３ ４ ５ ６ Pune MNC Pune Cantonment Khadki Cantonment Pimpri Chinckwas MNC Dehu Road cantonment Dehu C.T.

Nagpur １ ２ ３ Nagpur MNC Digdoh C.T.

Wadi C.T.

B Class Cities/Areas Naslk １ ２ ３ ４ Nashik MNC Eklaharc C.T.

Devlali Cantonlncnt Bhagur MC Amravati Amaravati MNC Aurangabad 1) Aurangabad MNC 2) Auraneabad Cantonment Bhiwandi 1)BhiWandi N」arnpur MNC 2)Khoni C.T.

Solapur Solapur MNC Kolhapur １ ２ Koplhapur MNC Gandhinaear C.T.

Vsai Virar Vasd Vairar MNC Malegaon １ ２ ３ ４ ５ ６ Malegaon MNC Dhaygaon O.G.

Daregaon O.G.

Soygaon C.T.

Dyane C.T.

Malde C.T.

Nanded Nandcd Waghala MNC Sangli １ ２ Sangli Miraj Kupwad MNC Madhavnaear C.T.

All District Headquarters other than those mentioned in A Class and B Class cities mentioned above this row.

District Headquarter means areas within the limits of respective Municipal Corporations and Municipal Councils of such District Headquarters.

C Class Cities/Areas Other than A and B Class Citics * C.T. Census Town * O.G. Out Growth ,■■ C:ヽ USers、 n■esh falke、 Desktop、 -5ヽ 31.05.2021師漱F可耶Π .d∝ x Page 2 ofAnnexure A