Seeking Prior Permission by Private Hospitals for Providing Certain Category of Treatment

Revision of guidelines for seeking permission by the state empanelled private hospitals from West Bengal Health Scheme Authority for providing treatment under West Bengal Health Scheme.

Government of West Bengal
Finance Department
Medical Cell, Writers’ Buildings

No. 41-F(MED)WB Dated- 21/03/2022

ORDER

Sub:- Revision of guidelines for seeking permission by the state empanelled private hospitals for providing treatment under West Bengal Health Scheme

Private empanelled hospitals are to seek prior permission mandatorily from West Bengal Health Scheme Authority (WBHSA) for providing certain category of treatment under West Bengal health Scheme in terms of Clause-14 of notification no. 797-F(MED)WB dated 31.01.2011, read with notification no. 11253-F(MED)WB dated 16.12.2011, 7578-F(MED)WB dated 04.09.2012 and Clause-8 of notification no. 108-F(MED)WB dated 19.12.2019.

With the introduction of recent online functionality of seeking prior permission through WBHS Portal and for advancement of medical science in modern time, revision of guidelines for asking permission on certain treatments was under active consideration of WBHSA to make it user friendly and convenient to its stakeholders.

Now, in partial modification of the above stated Orders, the Governor is pleased to introduce revised guidelines for seeking mandatory prior permission by the state empanelled private hospitals in connection with treatment under WBHS in the following manner:-

Sl. No.Category of treatmentEnclosures to be attached while seeking permission
1More than 2 procedures where total cost exceeds Rs. 50000/-Justification from the surgeon with supporting investigation reports.
2Implantation of More than 2 (Two) Drug Eluting StentOpinion of the cardiac surgeon on angioplasty with more than 2 stents instead of CABG, report of coronary angiography.
3Implantation of AICDJustification of the cardiac surgeon with supporting investigation reports.
4Implantation of CRT with AICDJustification of the cardiac surgeon with supporting investigation reports.
5Implantation of Deep Brain StimulatorJustification of the neuro-surgeon with supporting investigation reports.
6Implantation of Intra-Thecal PumpsJustification of the neuro-surgeon with supporting investigation reports.
7Implantation of CochlearJustification of the ENT surgeon with supporting investigation reports.
8Implantation of Spinal Cord StimulatorJustification of the neuro-surgeon with supporting investigation reports.
9Chemotherapy where medicine cost exceeds Rs. 50000/- per cycle (Once for entire chemo schedules)).Clinical findings from the treating oncologist regarding prognosis of the therapy and purpose (curative/palliative) including name of drugs and nos. of cycles. [Compliance of hospital under Clause 5 of Notification No. 11253-F(MED)WB dated 16.12.2011 shall not be required]
10**Non-package treatment whenever treatment cost exceeds Rs. 500000/- for Tata Medical Center, Rajarhat and Rs. 350000/- for other private empanelled hospitals.Clinical findings and prognosis of the treatment from the treating doctor along with reports of Procalcitonin, NT PRO BNP, CRP, CBC and Culture & Sensitivity in a chronological order.
11Successive permission after every 10 (ten) days against a permitted non-package treatment mentioned in Sl. No. 10.Clinical findings and prognosis of the treatment from the treating doctor along with reports of CRP, CBC and Culture & Sensitivity in a chronological order of successive 10 days.

** When a patient is treated in mixed mode i.e. both package and non-package, the treatment shall be considered as non-package treatment if the period of conservative/ medical management exceeds more than 10 days.

This order will come into effect from 01.04.2022.

This has the approval of Principal Secretary, Finance Department, Govt. of West Bengal.

ALOKE KUMAR MUKHERJEE, WBA & AS
Joint Secretary, Finance Department
Government of West Bengal

No. 41-F dated 21.03.2022, Source