The Aarogyasri Health Care Scheme was launched in the State by the erstwhile Government of A.P. with effect from 01.04.2007 to provide quality healthcare to the families below poverty line for treatment of identified diseases involving hospitalization, surgeries and therapies through an identified network of health care providers. In order to facilitate the effective implementation of the scheme, Aarogyasri Health Care Trust headed by the Chief Minister was set up. The empanelled hospitals comprise of both Government Hospitals and Corporate Hospitals. Out of the total number of 437 hospitals empanelled, Government hospitals comprise 152. Out of the 938 procedures covered under Aarogyasri Scheme, 133 have been earmarked for Government Hospitals, mainly with a view to improve the participation of Government Hospitals in the Scheme and utilization of part of the funds for development of the concerned Departments within the hospital and the hospitals itself. In order to strengthen the Government Hospitals a revolving fund has been created by the Trust.
2. The CEO, AHCT has requested for formulation of guidelines for releasing and optimum utilization of amounts to and by the Government Hospitals from the revolving funds. The Government after careful examination of the matter hereby issue the following guidelines for releasing of advances to the Government network hospitals from the Revolving Fund of the Trust so as to ensure optimum utilization of the fund by the Government Hospitals.
1. ORIGIN OF REVOLVING FUND:
Aarogyasri Healthcare Trust has created a “revolving fund” by deducting 20% of the package rates payable to empanelled Government hospitals for the treatment provided to the patients under the Rajiv Aarogyasri Scheme. The “Revolving Fund” is intended to provide advance assistance to Government Hospitals for procuring infrastructure required for treating Aarogyasri patients. The 20% deductions are being effected from 10-12-2008. The following procedures are however exempted from the deduction of revolving fund:
1. Maintenance of Haemodialysis for CRF
2. Cochlear implant surgery
3. Double valve replacement (with valve)
4. A.V. Fistula (Pre-transplant procedure only)
5. Renal Transplantation surgery
6. Post Transplant immunosuppressive treatment from 1st to 6th month after transplantation.
7.Post Transplant immunosuppressive treatment from 7th to 12th month after transplantation
Out of the 80% balance amount, 45% is earmarked for expenditure related to patient care and the remaining 35% for payment of incentives to the doctors and staff responsible for providing service to the beneficiaries under the scheme.
The advance provided from the “Revolving Fund” will, however, be recouped by the Trust from the payments to be made to the concerned hospitals for treating Aarogyasri patients.
2 SANCTIONING MECHANISM:
A. PROPOSALS FROM THE INDENTING HOSPITALS:
(i) The empanelled Government Hospitals both under the control of Director of Medical Education and the Commissioner of Vaidya Vidhana Parishad shall assess their infrastructure requirement (both medical and non- medical ie., civil works), well in advance, and submit proposals to the respective Head of the Department viz., Director of Medical Education, Commissioner, Vaidya Vidhana Parishad.
(ii) The proposals shall indicate the details of amounts received by the respective hospital from other sources such as Hospital Development Society, MSIDC., for such works in the past and the details of the expenditure made out of them.
(iii) The proposals shall also be accompanied by the ‘Utilisation Certificates’ for the amounts already received from the Aarogyasri Health Care Trust from the “Revolving Fund”.
(iv) The proposals shall also be accompanied by the details of the amounts so far received by the said hospital from the Trust, towards 45% of the package amount as per the apportionment ordered in G.O.Rt.No.134 HM&FW (K2) Dept dated 01-02-2010 r/w G.O.Rt.No.1344 HM&FW(M1) Dept dated 06-10-2010. The details of the expenditure made from the 45% package amount shall also be indicated.
B. SCRUTINY BY HEAD OF THE DEPARTMENT:
(i) The Director of Medical Education / Commissioner, VVP., after receipt of proposals from the respective hospitals, shall make a thorough scrutiny, make a specific recommendation and send the proposals to the Managing Director, MSIDC for further scrutiny and for forwarding the same to the Aarogyasri Healthcare Trust.
(ii) While doing so, the Head of the Department should satisfy himself that the proposal is in full shape and the Hospital has rendered proper accounts of the earlier sanctions made to the Hospital from various sources including Aarogaysri Healthcare Trust.
C. SCRUTINY BY MSIDC:
(i) The MS&IDC shall examine the proposal in the light of the established norms for procurement of such infrastructure / carrying out civil works and forward the same to the Aarogyasri Health Care Trust with specific recommendation.
(ii) Before forwarding the proposals to the Trust, the MS&IDC shall verify from its records, the sanctions made earlier to the said Hospital for such purpose and ensure that there is no duplication.
D. AAROGASRI HEALTH CARE TRUST:
(i) On receipt of the proposal, the Aarogyasri Health Care Trust will verify from earlier records, the releases made to the Hospital towards 45% of the package amount, the releases made from the “Revolving Fund” and whether proper accounts have been rendered / UCs submitted by the said Hospitals for the amounts received so far.
(ii) The Trust may constitute an internal Committee for the above purpose, which shall include Officers from the Finance Wing as well as from the Technical Wing, including doctors.
(III)Taking all aspects into consideration, the Trust may release the required amount from the “Revolving Fund” to the Hospital to the MD., TMSIDC under intimation to the Head of the Department and the hospital concerned.
3. EXECUTION MECHANISM:
(i) The MS&IDC will procure and supply the equipment / carry out the Civil Works, in the said Hospital, duly following the established procedure and financial rules.
(ii) The MS&IDC shall keep record of the entire process with reference to each Hospital so that the same could be available for audit at any given time.
4 RECOVERY / RECOUPMENT MECHANISM:
i) The amounts sanctioned from the Revolving Fund are required to be recouped by the Trust from the respective Hospitals to whom the amounts were advanced.
ii) It would be for the Chief Executive Officer, Aarogyasri Health Care Trust to devise a proper mechanism by developing required software, to account for the releases made both from the revolving fund and the package amounts to each Government Hospital under the Scheme.
iii) The amounts advanced from the Revolving Fund to a particular hospital shall be deducted from the future releases of 45% of package amount to be paid to the said hospital in a phased manner till that advance is entirely recouped.
5 MAINTENANCE OF RECORDS AND AUDIT REQUIREMENT:
i) The Trust / DME/Commissioner, VVP shall ensure that proper accounts are rendered by the respective Hospital for the amounts released earlier, before going for fresh releases.
ii) The Trust will also establish an ‘inspecting team’ who shall make a physical verification of the infrastructure procured / civil works carried out by the Hospital which received the advance from the “Revolving Fund”.
iii) The Trust shall maintain the cash flow records, hospital wise, as well as the total fund separately for proper auditing of fund.
iv) The amounts released by the Aarogyasri Health Care Trust are Government funds. As such, the provisions of Financial Code, Financial Rules, Regulations and other instructions issued from time to time by the Government shall apply in dealing with the “Revolving Fund”.
v) The participating Hospitals shall put in place an adequate, efficient, effective and sound internal control mechanism for handling the amounts received from the Aarogyasri Health Care Trust, both towards package amount and the “Revolving Fund”.
vi) Utilization Certificates shall be sent by the Hospitals to the Aarogyasri Health Care Trust as required under the rules and the Trust shall monitor receipt of the same from each Hospital.
3. The Chief Executive Officer, Aarogyasri Health Care Trust shall take necessary action in the matter.