The Maharashtra government, on late Tuesday night, issued an 18-page notification on the redressal of grievances concerning the exorbitant amount charged by healthcare providers from the patients who are not covered by any health insurance, any bilateral agreement or MoU between any hospital and private corporate group and who have exhausted their health insurance cover. Healthcare providers have been asked to increase their bed capacity, of which 80 per cent will be regulated with capped rates. On the remaining 20 per cent, rack rates can be charged.
For COVID-19 patients being treated in hospitals, nursing homes and clinics, its rates will not be more than what is prescribed and there will not be any difference in the quality of treatment. They will have to display the details of the rates and the package rate will include the doctors’ fee.
Further, healthcare providers situated in Mumbai, Pune, Navi Mumbai, Panvel and Thane having agreements/understanding as member of General Insurance Public Sector Associations (GIPSA) preferred private network (PPN) are prohibited from charging more than that applicable to the lowest bed category irrespective of the availability of beds in the lowest category agreed in their respective GIPSA-PPN agreement/understanding.
Many healthcare providers are not a part of GIPSA-PPN and have agreements/understandings with various Third Party Administrators (TPAs) pertaining to the package rates for different treatments. According to the government, such healthcare providers having different package rates for similar treatment with different TPAs should provide the treatment at the lowest package rate prevailing among different TPAs in its facility. Moreover, healthcare providers, who are not a part of GIPSA-PPN or who do not have any agreement with TPA will not charge more than the rates prescribed as per location and bed strength. These rates would be different depending upon the location of the hospitals and the number of operational beds.
Nursing and other support staff working in healthcare should give full support and extend wholehearted cooperation for the smooth functioning. Any group or union activities against the smooth functioning of the healthcare provider will attract penal provisions of the Maharashtra Essential Services Maintenance Act, 2005.
Healthcare providers may levy additional charges of not more than 5 per cent on the total bill, excluding items like pacemaker, stents, staplers, medical implants, PPE kits and intraocular lenses.