RFP DOCUMENT. RFP Document for Empanelment of Hospitals under Mukhyamantri Amrutum (MA) Yojana in Gujarat

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1 RFP DOCUMENT RFP Document for Empanelment of Hospitals under Mukhyamantri Amrutum (MA) Yojana in Gujarat Government of Gujarat Health and Family Welfare Department Gandhinagar Issued / Released on 19 th July, 2012 RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 1

2 GOVERNMENT OF GUJARAT DEPARTMENT OF HEALTH AND FAMILY WALFARE RFP NOTICE MUKHYAMANTRI AMRUTUM (MA) YOJANA Sealed bids are invited from the entities owning reputed private hospitals having experience of treating tertiary care illness for empanelment under Mukhyamantri Amrutum (MA) Yojana implemented for Below Poverty Line (BPL) families in all the 26 districts of Gujarat, namely Banaskantha, Sabarkantha, Dangs, Narmada, Tapi, Bharuch, Dahod, Kutch, Jamnagar, Patan, Anand, Vadodra, Valsad, Surat, Navsari, Ahmedabad, Gandhinagar, Mehsana, Kheda, Panchmahal, Surendranagar, Rajkot, Amreli, Bhavnagar, Junagadh, and Porbandar. The bids are invited in two parts i.e., Technical Bid and Financial Bid. The RFP document for this may be downloaded from the website The RFP document can also be obtained in person from the date of release 19/7/2012 from the below mentioned address on any working day between A.M and 4.00 P.M. The Technical Bids should be sealed by the Bidder in an envelope duly superscribed Technical Bid for empanelment under Mukhyamantri Amrutum (MA) Yojana. The Financial Bids is to be submitted through online only. The Technical Bids will be evaluated by the Technical Bid Evaluation Committee. Financial Bids of only the technically qualified Bidders shall be opened before the qualified Bidders by the State Nodal Cell (SNC) for awarding of the contract. The following schedule will be observed in this regard. 1. Pre bid meeting: 24/7/2012 (at noon) 2. Last date for online submission of Bids: 30/7/2012 (up to noon) 3. Last date for physical submission of Bids: 30/7/2012 (up to hrs) 4. Opening of Technical Bids: 31/7/2012 (at hrs) 5. Opening of Financial Bids: 6/8/2012(at hrs) The completed bid documents should be submitted before hrs. of 30/7/2012, at the following address:- Dr. B. K. Patel, Additional Director (FW), Commissionerate of Health and Family Welfare, MS and ME, Block No. 5, Dr. Jivraj Mehta Bhavan, Gandhinagar, Gujarat, Phone: , Fax: RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 2

3 TABLE OF CONTENTS A. PART-1 1. Introduction 4 2. Eligible health services providers 7 3. Implementation procedure 8 4. Empanelment procedure and disciplinary proceedings Grievance redressal mechanism IT infrastructure needed for empanelment Amendment of bidding document Notification of award and signing of agreement 19 B. PART-2 9. Submission of bids/proposals Draft Agreement between ISA and Hospital Detail of technical proposal (Annexure-2) Evaluation of technical bid process (Annexure-3) Financial Bid (Annexure-5) General guidelines on the benefit package (Anexure-6) General guidelines on Hospital Services (Anexure-7) Follow up surgeries for MA Yojana Beneficiaries (Annexure-8) Process Note for De-empanelment of Hospitals (Annexure-9) Roles and responsibility of Arogya Mitra (Annexure-10) Roles and responsibility of Hospital Arogya Mitra (Annexure-11) Role of Hospital Arogya Mitra in Medical Camp(Annexure-12) Network Hospital Do s & Don ts (Annexure-13) Undertaking to provide infrastructure at MA Kiosk (Annexure-14) Guidelines for poly trauma (Annexure-15) Guidelines for Laparoscopic Procedures (Annexure-16) Guidelines for Genito Urinary Procedure (Annexure-17) Guidelines for Triple Vessel Disease (Cardiothoracic) (Annexure-18) Guidelines for Cancer (Annexure-19) Guidelines for Burns (Annexure-22) Display of Bed status at MA Kiosk (Annexure-23) Format for Affidavit (tied up diagnostic facility)(annexure-24) Health camp guidelines (Annexure-26) Undertaking to share core banking number (IFC Code) (Annexure-27) District Wise BPL family Details (Annexure-28) Checklist (Annexure-30) Performance Security (Annexure-31) 214 RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 3

4 PART-I TERMS OF REFERENCE FOR SELECTION OF PRIVATE HOSPITALS FOR EMPANELMENT UNDER MUKHYAMANTRI AMRUTUM (MA) YOJANA 1. INTRODUCTION: A large number of households are pushed into poverty as a result of high costs of household spending on health care. The Below Poverty Line (BPL) population is especially vulnerable to catastrophic health risks. To address this key vulnerability faced by the BPL population in the state, the Government of Gujarat has taken a decision to launch a medical care scheme to be called Mukhyamantri Amrutum (MA) Yojana providing cashless treatment and coverage of catastrophic care targeted at the BPL population (hereinafter referred to as the Scheme ). The proposed Scheme will cover the entire State of Gujarat. State Nodal Cell has been set up by the Government of Gujarat, for the implementation of the Scheme. The State Nodal Cell will implement, establish, provide, administer, modify and supervise the Mukhyamantri Amrutum (MA) Yojana for providing medical care to the Beneficiaries. The Department of Health and Family Welfare, Government of Gujarat invites proposals for the empanelment of hospitals, for providing tertiary care health services under the Mukhyamantri Amrutum (MA) Yojana. Proposals are invited from the entities owning Private hospitals. Only the entities who are in agreement with the Scheme and the Terms of Reference contained in this FRP document, need to participate in the bidding and any disagreement in this regard may invite disqualification / rejection of bid at technical level. Hence all the Bidders are requested to go through the Scheme carefully and submit their Bids in the specific formats given in this RFP and agree to enter into the Service Agreement in the format given in this RFP, in case of empanelment. Finally, the award will be given to the entities owning the Hospitals that are selected by the Bid Evaluation Committee on the basis of both the Technical and Financial Bids, following due procedure. The selected Hospitals have to start the work immediately after the award. In case a selected Bidder declines to take up this work after a notice of award has been issued, it would be barred from applying for any such work or assistance of any kind from Department of Health and Family Welfare, Gandhinagar, Gujarat for a RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 4

5 period of 3 years from the date of such award. The decision of the Bid Evaluation Committee shall be final, and no enquiries, or application for review, shall be entertained. 2. OBJECTIVE : The objective of the Scheme is to improve access of BPL families to quality medical and surgical care for treatment of identified diseases involving hospitalization, surgeries and therapies through an empanelled network of health care providers. 3. BENEFICIARIES: The Scheme is intended to benefit Below Poverty Line (BPL) Families of the 26 districts of Gujarat, namely Banaskantha, Sabarkantha, Dang, Narmada, Tapi, Bharuch, Dahod, Kutch, Jamnagar, Patan, Anand, Vadodra, Valsad, Surat, Navsari, Ahmedabad, Gandhinagar, Mehsana, Kheda, Panchmahal, Surendranagar, Rajkot, Amreli, Bhavnagar, Junagadh, and Porbandar. According to a recent enumeration made by the Rural and Urban Development Department, there are approximately 39 lakh BPL families in the said twenty six districts of the State. Database and photographs of these families are available in the form of Bar Coded Plastic Cards issued by the Commissionerate of Health and Family Welfare, Gandhinagar. However the number of Bar Coded Plastic Card holders is subject to increase or decrease. District-wise profile of the BPL families is given in Annexure BPL FAMILY: A family would comprise the head of the family, spouse, and up to three dependents. The dependents would include such members as listed as part of the family in the beneficiary database provided by the Rural and Urban Development Department, Gandhinagar. 5. SUM INSURED ON FLOATER BASIS: The Scheme provides coverage for meeting expenses of hospitalization and surgical procedures of the beneficiary members up to Rs.2.0 lakhs per family of five members per year subject to limits, in any of the Network Hospitals. The benefit on family will be on floater basis i.e. the total reimbursement of Rs.2.0 lakhs can be availed of individually or collectively by members of the family. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 5

6 6. BENEFITS: All predefined medical procedures and other services as part of the disease/treatment packages would be provided on a complete cashless basis. An enrolled BPL beneficiary may go to any Network Hospital with the Bar Coded Plastic Card and come out without making any payment to the Hospital for these procedures covered under the Scheme. 1 Burns (a total 12 Benefit Packages) 2 Cardiovascular Surgeries (a total 153 Benefit Packages) 3 Renal (a total 21 Benefit Packages) 4 Neurosurgeries (a total 49 Benefit Packages) 5 Poly Trauma (Not covered by Motor Vehicle Insurance) (a total 8 Benefit Packages) 6 Neo-natal diseases (a total 23 Benefit Packages) 7 Cancer (Surgical Oncology, Chemotherapy & Radiation Oncology) (a total 210 Benefit Packages) In addition, there will be no pre-existing condition exclusions. Pre-existing diseases are also covered from day one which means that any illnesses existing prior to the inception of the Scheme shall also be covered. Provision for transport allowance of Rs.300 per visit subject to an annual ceiling of Rs.3000 shall be a part of the total coverage of Rs 2,00,000/- per family. 7. ELIGIBLE HEALTH SERVICES PROVIDERS: 7.1 Empanelment of Public/Grant in Aid hospitals: All Government/Grant in Aid hospitals as decided by the State Government shall be empanelled. 7.2 Criteria for Empanelment of Private Providers: The empanelment criteria of the Health Services Providers is defined and listed in Part II of this RFP Document, under the head of Eligibility Criteria. The Implementation Support Agency (ISA) shall sign Service Agreements with the entities owning all the Hospitals to be empanelled under the Scheme. The empanelled Hospitals shall extend medical aid to the Beneficiaries as per the Scheme. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 6

7 8. ADDITIONAL BENEFITS TO BE PROVIDED BY HEALTH SERVICES PROVIDERS In addition to the benefits mentioned above, both Public and Private Health Services Providers should provide free Registration and free OPD consultation to the MA enrolled Beneficiaries. 9. ADDITIONAL RESPONSIBILITIES OF THE HEALTH SERVICES PROVIDERS In addition to providing cashless treatment, the Health Services Providers shall: a. Display clearly their status of being an empanelled provider of Health Services under the Mukhyamantri Amrutum (MA) Yojana, in the prescribed format given by State Nodal Cell, at their main gate. b. Maintain a functional help desk for giving necessary assistance to the MA Beneficiaries. At least two persons in the Hospital shall be nominated by the Hospital, who will be trained in different aspects of MA Yojana by the ISA. c. Display a poster near the reception/admission desks along with the other materials supplied by the ISA for the ease of Beneficiaries, Government and ISA. The template of empanelled status and poster for reception area will be provided by the State Nodal Cell. d. Send Hospitalisation data of MA patients electronically on a daily basis to the designated server. 10. ADDITIONAL SERVICES TO BE PROVIDED BY THE NETWORK HOSPITALS: The Health Services Providers / Network Hospitals shall provide the following additional services to the Beneficiaries: a) Provide space and separate Mukhyamantri Amrutum (MA) Yojana counter / kiosk as per the design provided by ISA for Arogya Mitras (Health Coordinators). b) Provide computer with networking (dedicated broadband with minimum 2 mbps speed), printer, webcam, scanner, bar code reader, biometrics, digital camera and digital signatures. c) Provide free food for the patient and also provide transport / transportation charges for the patient on discharge (Rs. 300/- with a ceiling of maximum Rs.3000/- per year) which will be the part of package rates. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 7

8 d) Provide free OPD/diagnostic tests irrespective of surgeries/procedures and medical treatment required for the Beneficiaries irrespective of the procedure. There shall not be any cash transaction for MA patients. 11. SPECIAL FUNCTIONARIES TO BE PROVIDED BY THE NETWORK HOSPITALS: The Network Hospitals shall Provide the services of a dedicated Medical Officer to work as Hospital Arogya Mitra for the Scheme and he will be responsible to the State Nodal Cell and the ISA for doing various activities under the Scheme including Health Camps, Follow-up of referred patients from camps, diagnosis, out-patient 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. At the Hospital level, the Hospital Arogya Mitra will coordinate with Arogya Mitra and the Beneficiary. The role of Hospital Arogya Mitra (HAM) is attached as Annexure IMPLEMENTATION PROCEDURE: The entire Scheme is intended to be implemented as cashless Hospitalization. a) Package Rates: The package rates would include consultations, medicine, diagnostics, food, Hospital charges, etc. as indicated in the treatment package. b) Health Camps: Health Camps are to be conducted by the Network Hospitals in various Taluka Head Quarters/ Gram Panchayats/ Municipalities/ Municipal Corporations. The Implementation Support Agency will assist the Hospital in conducting such medical camps at the place and time suggested by the Authorities of District/ Municipal Corporation/State Nodal Cell. Network Hospitals shall provide necessary screening equipment and the required specialists and other para-medical staff for the Health Camps. c) Procedure for availing treatment in the Network Hospitals by the Beneficiaries: Step 1: The Beneficiaries approach the nearby Sub District Hospital/District Hospital/Medical College & Hospital/Network RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 8

9 Hospital. Arogya Mitras would facilitate the Beneficiary. If the Beneficiary visits any other Government hospital other than the Network Hospital, the doctors will give him/her a referral card to the Network Hospital after preliminary diagnosis. The Beneficiary may also attend the Health Camps being conducted by the Network Hospitals and can get the referral card based on the diagnosis. Step 2: The Arogya Mitras engaged by the Implementation Support Agency examine the referral card and the Bar Coded Plastic Card and facilitate the Beneficiary to undergo preliminary diagnosis and basic tests. Step 3: The Network Hospital, based on the diagnosis, admits the patient and sends preauthorization request to the Implementation Support Agency. Step 4: Doctors/Specialists of the Implementation Support Agency examine the preauthorization request and approve preauthorization within 24 hours on receiving the preauthorization request from the Network Hospitals, if all the conditions are satisfied. Step 5: The Network Hospital extends cashless treatment and surgery to the Beneficiary subject to the limits prescribed under the Scheme. Step 6: The Network Hospital after discharge of the patient, forwards the original bill, discharge summary with signature of the patient and other relevant documents within one week from the date of discharge of the patient, to the Implementation Support Agency for processing and settlement of the claim. Step 7: The Implementation Support Agency scrutinizes the bills and forwards the payment request of the bill to the State Nodal Cell within seven days of the receipt of bills from the Network Hospital. Step 8: The State Nodal Cell after verification of the bills in respect of the services provided, will directly make the payment by way of electronic transfer to the Network Hospital(s) within 30-days of receiving the bills from the Implementation Support Agency. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 9

10 Note: The Network Hospital has to regularly display/update and report the total bed occupancy against availability. Looking to the patients load and in order to maintain quality of services, the State Government may direct patients to a particular Network Hospital. d) MIS/ IT Platform: The Network Hospital will use the IT platform developed by the ISA/State Nodal Cell to conduct all transactions related to the Mukhyamantri Amrutum (MA) Yojana. Transactions including planning and schedules of medical camps, e-preauthorization, processing of claims and claims settlement among others will be conducted on the MUKHYAMANTRI AMRUTUM MA WEB PLATFORM. e) Arogya Mitra and District Level Co-ordination: The ISA is responsible for identifying, engaging, training and positioning the Arogya Mitras at the Network Hospitals and District Coordinators at districts. The Network Hospitals shall provide the Arogya Mitras with necessary infrastructure, including table, computer and broadband connectivity etc. They should ensure that health camps are held as per schedule, arrange for canvassing for the camp, mobilize patients and follow up the Beneficiaries. 13. PUBLICITY: The Implementation Support Agency on its part will ensure that proper publicity is given to the Scheme. The publicity materials including list of empanelled Network Hospitals, brochures, banners, display boards etc. supplied by the State Nodal Cell, shall be displayed in public places. 14. EMPANELMENT PROCEDURE AND DISCIPLINARY PROCEEDINGS: i. Empanelment: The District Advisory and Grievance Redressal Committee (DAGRC) will ensure that the Network Hospitals are having adequate infrastructure, man power, equipment etc., as per the standards listed for empanelment of Hospital under the Scheme. ii. Disciplinary actions and De-listing: On recommendation by the District Advisory and Grievance Redressal Committee (DAGRC), the SNC/ISA shall take various disciplinary actions against any Network Hospital including de-listing from the RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 10

11 empanelment if it is found that guidelines of the Scheme are not followed by it and services offered are not satisfactory as per laid down standards. The Hospital may also be delisted or de-empanelled if the infrastructure in the Hospital is found below the standards laid down by State Nodal Cell any time during the empanelment period. 15. EARNEST MONEY DEPOSIT (EMD): 15.1 Each Proposal shall be accompanied by EMD of Rs.1,00,000 (Rupees one lakh only). 15.2The EMD shall be in the form of a crossed demand draft / banker s cheque drawn in favour of State Health Society, Gandhinagar, on any scheduled bank, payable at Gandhinagar The EMD of unsuccessful Bidders would be returned within a period of eight weeks from the date of announcement of the Successful Bidder. The EMD submitted by the Successful Bidder would be released upon furnishing of the Performance Security amounting to Rs Lakhs (Rupees ten lakhs only) for the first year. For the second year onwards for every renewal year, the Performance Security amount would be equivalent to 10% of the total claims occurred under MA Yojana in the previous year at the Network Hospital. Failure of the Successful Bidder in furnishing the Performance Security as above shall constitute sufficient grounds for the annulment of the Letter of Award (LoA) and discontinuation of the Successful Bidder from MA Yojana. 16. EARNEST MONEY REFUND: 16.1 In case the Bid is rejected on technical grounds, the Earnest Money would be refunded within 7 days from the bid opening In case the Bid is rejected after inspection, on the grounds of submitting incorrect information, then 50% of the Earnest Money would be forfeited and the balance would be refunded in due course In case, the Bidder refuses to sign the Service Agreement, 50% of the Earnest Money would be forfeited. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 11

12 17. PERFORMANCE SECURITY: 17.1 The Successful Bidders shall have to furnish within a period of 7 (seven) days from the date of issue of Letter of Award, Performance Security in the form of Bank Guarantee of any scheduled bank, of Rs Lakhs (Rupees ten Lakhs only) valid for a period of one year, in favour of State Health Society, Gandhinagar to ensure efficient service and to safeguard against any default. The Performance Security shall be in the format provided in Annexure From the next year onward for every renewal year, the Performance Security amount would be equivalent to 10% of the total claims occurred under MA Yojana in the previous year at the Network Hospital The Performance Security shall be discharged and released on submission of the Performance Security for the next year, as mentioned above. 18. LIQUIDATED DAMAGES: 18.1 The Network Hospital shall provide the services as per the requirements specified by the MA Yojana and in terms of the provisions of the Agreement with ISA. In case of initial violation of the provisions of the Agreement by the Hospital such as refusal of service or direct charging from the MA Beneficiaries or defective service and negligence, the amount equivalent to 50% of the amount of Performance Security will be charged as agreed Liquidated Damages by the ISA/SNC. The Liquidated Damages shall be adjusted against the amounts payable to the Network Hospital. In the event of the amount payable to the Network Hospital being less than the amount of Liquidated Damages, the balance amount shall be recovered by invoking the Performance Security. In such event, the Network Hospital shall replace the Performance Security by a fresh Bank Guarantee, for the full amount as required In case of repeated defaults by the Network Hospital, the total amount of Performance Security shall be forfeited and action will be taken for removing the Hospital from the empanelment of MA Yojana as well as termination of the Service Agreement RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 12

13 18.3 For over-billing and unnecessary procedures, the extra amount so charged will be deducted from the pending / future bills of the Hospital and the ISA/SNC shall have the right to issue a written warning to the Hospital not to do so in future. 18.4The recurrence, if any, of over-billing and unnecessary procedures or defaults will lead to the stoppage of referral to that Hospital. 19 MEDICAL AUDIT: The success of the Scheme rests on ensuring that all the stakeholders adhere to the highest level of medical ethics. The ISA shall recruit specialized doctors for regular inspection of Hospitals, to attend to complaints from Beneficiaries directly or through Arogya Mitras for any deficiency in services by the Hospitals and also to ensure proper care and counseling for the patients at Network Hospitals by coordinating with Arogya Mitras and Hospital authorities. 20 CASHLESS SERVICE: The Hospitals have to ensure that all the Beneficiaries are provided with adequate facilities and treatment without the need to pay any deposits right from the entry into the Hospital, till the expiry of 10 days post discharge, for all the procedures covered under the Mukhyamantri Amrutum (MA) Yojana. It is envisaged that for each Hospitalization the transaction shall be cashless for covered procedures. Enrolled BPL Beneficiary will go to Hospital and come out without making any payment to the Hospital subject to procedure covered under the Scheme. The same is the case for diagnostics if eventually the patient does not end up in undergoing the surgery or therapy. 21. CLAIMS: The Beneficiaries would be identified by the Mukhyamantri Amrutum Bar Coded Plastic Card at the Mukhyamantri Amrutam Assistance Counter at the Network Hospital, by the Arogya Mitra Hospital. After the verification of the patient, the treatment will be cashless for all the covered procedures. The State Nodal Cell will make payment of the claims directly to the Hospital within 30 days of the receipt of all documents from the ISA. The cost of various tests conducted on BPL family members who ultimately do not undergo surgery or therapy, will not be included in the claims. However the Hospital will ensure that such tests are done free of cost to the patient. The claims procedure will be RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 13

14 carried on the electronic platform of the ISA/MA portal. The processing of the claims will be handled by the ISA. The claims procedure will be undertaken as detailed below (preferably electronically): 1. Claim Intimation: The Hospital will submit the request to the ISA after verifying the patient through Bar Coded Plastic Card in the form as agreed under the Scheme, and after treatment and discharge of the patient. The ISA/State Nodal Cell portal will have reports indicating claim intimations received. 2. Collection of Claim documents: The Network Hospital will send the claim documents along with the electronic medical records or as directed by ISA via the ISA/MA web portal to the ISA. The ISA will scrutinize the claim documents at the initial stage from the stand point of non-medical and medical eligibility criteria. Deficiency of any documents shall be communicated to the Hospital within 7 working days. A reminder for the same will again be forwarded to the Hospital once every 3 days of first intimation if the deficient documents are not received or are partially received. 3. Repudiation: In case of repudiation of the claim not covered under the Scheme, ISA will mention the reasons for repudiation in writing and online to the Network Hospital. 4. Appeal and Reopening: The Network Hospital shall have a right to approach the ISA if the Network Hospital feels that the claim is wrongly repudiated. If the Network Hospital does not agreed with the ISA s decision in this regard, it can appeal to the DAGRC of the respective district. The decision of the DAGRC will be final and binding on the ISA and the Network Hospital. This right of appeal will be mentioned by the ISA in every repudiation advice as mentioned above. The DAGRC can reopen the claim if proper and relevant documents as required are submitted. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 14

15 5. Review: The State Nodal Cell/ISA will have the right to reopen a settled claim. The Network Hospital further agrees to provide access to its records for this purpose. All the claims settled by the State Nodal Cell to the Network Hospitals based on the bills received from the Hospitals in conformity with the package rate arrived at and also based on the preauthorization given by the ISA may be verified by the State Nodal Cell for grievances. 22. GRIEVANCE REDRESSAL MECHANISM: There shall be the following set of Grievance Redressal Committees to attend to the grievances of various stakeholders at different levels: 22.1 District Advisory & Grievance Redressal Committee (DAGRC): This will be constituted by the State Nodal Cell in each district. The District Advisory & Grievance Redressal Committee (DAGRC) will be as follows: a) District Magistrate- Chairman b) District Development Officer- Co-Chairman c) Regional Deputy Director d) Chief District Medical Officer- Convener e) Chief District Health Officer f) Representative of the ISA g) Parties with grievances (Beneficiary/hospital/ISA/District) In Municipal Corporation area the Advisory & Grievance Redressal Committee will be Municipal Corporation Advisory & Grievance Redressal Committee (MCAGRC): a) Municipal Commissioner- Chairman a) Deputy Municipal Commissioner (Health)- Co-Chairman b) Regional Deputy Director c) Medical Officer of Health - Convener d) Chief District Health Officer e) Representative of the ISA f) Parties with grievances (Beneficiary/hospital/ISA/District/ Municipal Corporation) District and Municipal Corporation administration may co-opt more members for this purpose. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 15

16 22.2 State Empanelment Grievance Redressal and Disciplinary Committee (SEGRDC): This will be constituted by the State Government. The State Empanelment Grievance Redressal and Disciplinary Committee will be as follows: a) Principal Secretary (PH) and Commissioner (Public Health): Chairman. b) Principal Secretary (Expenditure), ex- officio c) Mission Director, NRHM, ex- officio d) Project Director, State Nodal Cell- Convener e) Deputy Secretary (FW & RH) f) Additional Director (FW) g) Additional Director (Public Health) h) Additional Director (ME) i) Additional Director (MS) j) Representative from U. N. Mehta Hospital, Ahmedabad. k) Representative from Kidney Hospital, Ahmedabad. l) Representative from Cancer Hospital, Ahmedabad. m) Representative from Civil Hospital, Ahmedabad. n) Representative from Civil Hospital, Ahmedabad. o) Representative from Civil Hospital, Ahmedabad. p) Representative from Civil Hospital, Ahmedabad. q) State Representative of the ISA r) Managing Director (n) Code Solutions. s) Parties with grievances (Beneficiary / hospital/ ISA/ District/ Municipal Corporation) State Nodal Cell may co-opt more members for this purpose. If any stakeholder has a grievance against another one, in connection with the validity, interpretation, implementation or alleged breach of any provision of the Scheme, it will be settled in the following way: A. GRIEVANCE OF A BENEFICIARY: If a Beneficiary has a grievance on issues relating to enrolment or Hospitalization against the ISA, Hospital or their representatives, the Beneficiary will approach DAGRC. The DAGRC should take a decision within 30 days of receiving the complaint. If either of the parties is not satisfied with the decision of DAGRC, they can appeal to the SEGRDC. The SEGRDC shall decide the appeal within 15 days of receiving the appeal. The decision of the SEGRDC on such issues will be final. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 16

17 B. GRIEVANCE OF A HOSPITAL: If a Hospital has any grievance with respect to a Beneficiary, ISA or their representatives, the Hospital will approach the DAGRC. The DAGRC should reach a decision within 30 days of receiving the complaint. If either of the parties is not satisfied with the decision, they can go to the SEGRDC which shall take a decision within 15 days of receipt of appeal. The decision of the SEGRDC shall be final. C. GRIEVANCE OF AN ISA: If an ISA has any grievance with respect to a Beneficiary, or District Authorities, it will approach the DAGRC. The DAGRC should take a decision within 30 days of receiving the complaint. If either of the parties is not satisfied with the decision, they can Appeal to the SEGRDC. The SEGRDC shall decide the appeal within 15 days of receiving the appeal. The decision of the SEGRDC on such issues will be final. If ISA has a grievance against the District Key Manager or an agency of the State Government, it can approach the SEGRDC for resolution. The SEGRDC shall decide the matter within 30 days of the receipt of the grievance. The decision of SEGRDC shall be final. 23 IT INFRASTRUCTURE NEEDED TO BE PROVIDED BY THE HOSPITALS EMPANELLED UNDER THE MUKHYAMANTRI AMRUTUM ( MA ) YOJANA. Both public and private Hospitals which fulfill the criteria for empanelment and are selected for empanelment under the MA Yojana by the ISA will need to put in place such infrastructure and install such hardware and software as given in Annexure-4, within a period of days from the date of issue of the Letter of Award. It will be the responsibility of the empanelled Hospitals to procure and install Bar Coded Plastic Card related devices in the Hospital. The cost of procurement installation and maintenance of these devices will also be the responsibility of the empanelled Hospitals. 24 CLAIM FLOAT AND BANK ACCOUNT: The Network Hospital shall open and maintain a separate Bank account to receive payments against valid claims and all payments will be RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 17

18 electronically cleared on the MA portal. Detailed reports will be made available online on a real-time basis. 25 PERIOD OF CONTRACT: The ISA will sign the Service Agreement / contract with the successful Bidder. The period of contract will be for one (1) year from the date of signing the Service Agreement. 26 INSPECTION BEFORE EMPANELMENT: The Hospital will be inspected by the experts from the District/ISA/State Nodal Cell before empanelment. The District Empanelment and Disciplinary Committee will scrutinise the application, inspection reports and other material facts for empanelling the Hospital. 27 DELISTING AND OTHER DISCIPLINARY ACTION: An empanelled Hospital would be de-listed from the MA network if, it is found that guidelines of the Scheme are not followed by it and / or the services offered are not satisfactory as per laid down standards. The ISA will follow the Guidelines for de-empanelment for Hospitals as given in Annexure-9. A Hospital once de-empanelled from the Scheme, in accordance with the procedures laid down in Annexure-9, Scheme shall not be empanelled again for at least a period of one year. The State Empanelment Grievance Redressal and Disciplinary Committee will look into all complaints and grievances received from the patients, and the field, vigilance and other inspection teams with regard to the quality of services and compliance with the Service Agreement clauses and may recommend disciplinary action including delisting of the Hospital. 28 AMENDMENT OF BIDDING DOCUMENTS: a) At any time prior to the deadline for submission of bids, the State Government/State Nodal Cell may, for reasons to be recorded in writing, modify the Bidding documents. b) The amendments will be notified in writing or by fax or or through State Government website to all prospective Bidders who RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 18

19 have acquired the Bidding documents and the amendments will be binding on them. c) In order to afford prospective Bidders reasonable time to take the amendments into account in preparing their bids, the State Government/State Nodal Cell may, at its discretion, extend the deadline for the submission of the Bids. NOTE: Oral statements made by the Bidder at any time regarding quality of service or arrangements or any other matter shall not be considered. 29 STATE GOVERNMENT/ STATE NODAL CELL S RIGHT TO ACCEPT OR REJECT ANY OR ALL BIDS: The State Government/State Nodal Cell reserves the right to accept or reject any Bid or annul the Bidding process and reject all Bids at any time prior to award of contract, without assigning any reason therefore, and without thereby incurring any liability or obligation to the affected Bidder(s). The State Government/State Nodal Cell is not bound to accept the lowest or any bid. Note: Incomplete technical bids and financial bids with extra attachments/remarks are liable to be disqualified. 30 VALIDITY OF RFP: This RFP will be valid for a period of one (1) year from the date of issue and if implementation of the Scheme in any district does not commence by way of issue/renewal of Bar Coded Plastic Cards within that time, a new RFP will need to be floated by the State Nodal Cell. 31 NOTIFICATION OF AWARD AND SIGNING OF AGREEMENT: The Notification of Award will be issued with the approval of the Executive Committee constituted as per the GR dated 2 nd June, The terms of Agreement will be discussed with the representatives of the successful Bidders and the successful Bidder is required to sign the Service Agreement with the ISA in duplicate within 15 days of issue of the Letter of Award. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 19

20 32 CANVASSING: Bidders are hereby warned that canvassing in any form for influencing the process of notification of award would result in disqualification of the Bidder. 33 SIGNATURE ON EACH PAGE OF BID DOCUMENT: Each page of Bid Document submitted by the Bidder must be signed by the authorized signatory of the Bidder. The Bidder shall also submit along with the Bid, the authorization / Power of Attorney issued in favour of the authorized signatory. Any document/sheet not signed shall tantamount to rejection of the Bid. 34 DEADLINE FOR SUBMISSION BIDS/PROPOSALS: Complete bid documents should be submitted at the address mentioned below not later than hours on July, Bid documents received later than the prescribed date and time will not be considered for evaluation. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 20

21 SUBMISSION OF BIDS/ PROPOSALS PART-II 35. SUBMISSION OF BIDS The Government of Gujarat/Mukhyamantri Amrutum ( MA ) Agency seeks detailed proposals from the entities owning Hospitals interested in empanelment under Mukhyamantri Amrutum (MA) Yojana in the State. Hospitals having branches in various districts will be considered as a separate entities and needs to apply separately. The bid/proposal document should include the following: 36. TECHNICAL PROPOSAL: Technical Proposal shall be provided in the format given in Annexure 2 and as per instructions contained in Annexure The Bidder shall provide the details of infrastructure available in the Hospital, i.e., no. of available beds, services available at the Hospital etc. for performing the assignment. 2. The Bidder shall provide adequate proof to show that it owns the Hospital whose services are being offered under the Scheme. 3. Format for evaluation of technical proposal has been given in Annexure Technical bid evaluation will be done in following steps: a. The Bidders will be shortlisted based on the qualifying criteria. The Inspection Committee will visit the Hospitals and submit its recommendation to the technical evaluation committee. b. All the successful bidders (recommended by inspection committee) who qualify after the technical bid evaluation will be eligible for the financial bid evaluation. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 21

22 37. Eligibility Criteria: 1. The Hospital should have at least 25 beds with following infrastructure: 1) General Ward: 1 Nurse: Per 10 patients with 24 hrs services in 3 shifts in a day 1duty doctor: Per 10 patients with 24 hrs service in 3 shifts in a day The space between two beds should be at least 5 feet The Hospital should have separate male and female wards 2) ICU Beds: The Hospital should have at least 3 ICU beds. 1 Nurse: Per 1 patient with 24 hrs service in 3 shifts in a day. 1 duty doctor: Per 4 to 5 patients with 24 hrs service in 3 shifts in a day. The ICU ward should be equipped with ventilators, defibrillators, monitors, central oxygen line, suction apparatus and pulse oxymeter. 3) The Step down ICU ward: The Hospital should have at least 2 Step down ICU beds 1 Nurse: Per 3 patients with 24 hrs service in 3 shifts in a day. 1 duty doctor: Per 4 to 5 patients with 24 hrs services in 3 shifts in a day The Step down ICU ward should be equipped with defibrillators, monitors, central oxygen line, suction apparatus and pulse oxymeter. 4) The post operative ward: The Hospital should have at least 2 beds in the post operative ward 1 Nurse: Per 1 patient with 24 hrs service in 3 shifts In a day 1 duty doctor: Per 4 to 5 patients with 24 hrs services in 3 shifts in a day. The post operative ward should be equipped with ventilators, defibrillators, monitors, central oxygen line, suction apparatus and pulse oxymeter. Note: Fully qualified nursing staff and allopathic doctors should be available round the clock as aforesaid under the protocol of the Hospital. Further ICU ward is not essential for ophthalmology speciality Hospital. 2. The Hospital should have well equipped operation theatre with the following equipments: 1) Boyles apparatus 2) Endoscopes as per requirement of speciality 3) Monitor with defib. multipara monitor 4) Diathermy (Bipolar, Unipolar cautery) 5) Laproscopic Equipment if necessary as per the speciality treatment RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 22

23 catered 6) Operating Microscope if necessary as per the speciality treatment catered 7) Suction apparatus 8) Pulse oxymeter 9) Sterility unit and other equipment as per the specialities treatment available (autoclaves, facility for sterilizing non autoclavable equipments instruments) 3. The Hospital should have the following full equipped diagnostic facilities: The Hospital shall facilitate free diagnostic facilities and advance diagnostic tests in-house or either in the tied-up diagnostic centres, such as: 1 In house mandatory diagnostic facilities Radiology: X-Ray, USG and ECG Biochemistry, Micro biology & Serology, Haematology. 2 Advance diagnostic tests in house/tie-up CT, MRI, ECHO, Pathology etc. Note: The Hospital as well as tied up diagnostic centres shall furnish affidavit about extending free diagnostic tests for the Scheme members as tied up diagnostic centre. 4. The Hospital shall have round the clock blood bank facility in house/tied up. 5. The Hospital should have qualified anaesthetist round the clock in house/on call. 6. The Hospital shall maintain complete record on day to day basis and shall provide records of the patients to ISA/State Nodal Cell as and when it is required. 7. The Hospital shall ensure cashless facility to the Scheme members as per the surgery packages devised by the ISA/State Nodal Cell. The surgery package includes cost of consultation, medicine, diagnostics, implants, food, transportation charges, OT charges, professional fees, Hospitalization charges and follow up treatment with medicines, in other words the package RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 23

24 includes entire cost of treatment of the patient from the date of admission to the date of discharge with follow-up treatment cost. 8. The Hospital shall provide transportation charges to Rs.300/- per visit with a maximum limit of Rs.3000/- per year. 9. The Hospital should have sufficient experienced specialists / super specialists in the specific identified fields (as per point no. 2) for which the Hospital is empanelled. 10. For extending the treatment of chemotherapy and radiotherapy the Hospital should have infrastructure for radiotherapy and full time Radiation Oncologist and Medical Oncologist must be available. 11. The Hospital shall furnish the chemotherapy drugs bills along with empty vials and quote the batch no. of the drugs with label intact. (Drugs with generics names should be preferred) 12. The Hospital should have full time services of qualified plastic surgeon with requisite infrastructure for corrective surgeries for post burn contractures. 13. The Hospital should have round the clock in-house pharmacy. 14. The Hospital should have full time/on call services of pediatric surgeons / plastic surgeons / urologist surgeons related to congenital malformation in pediatric age group (less than 14 years). 15. The Hospital shall provide the following additional facilities and benefits to the BPL patients: a) Shall ensure exclusive health cell/kiosk for MA Yojana to enable the Arogya Mitra to execute his/her duties. b) Shall provide a computer with networking (dedicated broadband with minimum 2 mbps speed), Printer, Scanner and digital camera. c) Shall ensure a dedicated medical officer to work as Hospital Arogya Mitra ( medical coordinator) for the Scheme and he/she will be responsible for various activities of the Scheme such as health camps, RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 24

25 follow up of referred patients from the camps, diagnosis, outpatient details, E-Preauthorization, surgeries, feedback on the patients condition and service offered by the Hospital duration during hospitalization of the patient, discharges, deaths if any, free consultation for the follow up patients and distribution of medicines after discharge etc. d) Shall conduct minimum number of free health camps as stipulated in the Service Agreement for identifying and screening of the BPL patients suffering from the identified ailments. The Hospital shall have a mobile team with the diagnostic equipments and team of doctors as specified by the ISA/State Nodal Cell for conducting health camps. For this purpose, the villages are identified by the District administration/isa/state Nodal Cell and communicated to the Hospital. 16. Specific criteria for Cancer: The Hospital shall agree to provide the services of fully qualified surgical oncologist and medical oncologist to treat patients requiring surgical and chemotherapy treatments. Further to treat patients requiring surgical, chemotherapy and radiotherapy treatments the Hospital shall provide the services of surgical oncologist, medical oncologist, radiation oncologist and equipment for cobalt therapy, linear accelerator radiation treatment and brachy therapy for empanelment under MA Yojana. In case facilities such as chemotherapy and radiotherapy are not available in the Hospital, the Hospital shall not perform surgery alone and refer the patients to other centers for follow-up treatments requiring chemotherapy and radiotherapy treatments. Chemotherapy and radiotherapy should be administered only by professionals well versed in dealing with the side-effects that the treatment can cause. Patients with hematological malignancies (Ex. Leukemia, Lymphomas and Multiple Myeloma) and pediatric malignancies (any patient below 14 years of age) should be treated by qualified medical oncologist only. Chemotherapy has to be administered to the patient as in-patient treatment only. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 25

26 The Hospital shall agree to provide the services as per the packages and adhere to the treatment protocols, referred to in Annexures- 19, 20 and 21. The Hospital shall agree to quote batch no. of the drugs and attach empty vials and ampules with labels intact along with the bills. The Hospital shall agree to give patient feedback through multimedia using webcam and mike. The provision for live viewing of the patient will be provided in the Implementation Support Agency (ISA) portal. 17. Specific Criteria for Polytrauma: The Hospital shall have Emergency Room setup with round the clock dedicated duty doctor. The Hospital shall have round the clock anesthetist services. The Hospital shall provide round the clock services of Neurosurgeon, Orthopedic Surgeon, CT Surgeon, General Surgeon, Vascular Surgeon and other support specialists. The Hospital shall have dedicated round the clock Emergency theatre, surgical ICU, and post-operation setup with qualified staff. The Hospital shall provide necessary cashless diagnostic support round the clock, including specialized investigations such as CT, MRI and emergency biochemical investigations. The Hospital shall have in place all necessary infrastructure required for preauthorization round the clock. The Hospital shall agree to provide the services as per the packages and adhere to the treatment protocols, referred to in Annexure Specific criteria for Pediatric Congenital Malformations and Post Burns Contractures: RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 26

27 The Hospital shall have services of qualified specialists in various fields viz., pediatric surgeon, plastic surgeon with dedicated theatres, postoperation setup and staff. Note: a. In the absence of any one of the above, the offer will be treated as nonresponsive and summarily rejected. b. Relevant documents in support of the above criteria must be enclosed along with the Bid documents failing which the Bid will be liable to be rejected. c. The Financial Bids of the Bidders, unsuccessful in the technical evaluation shall not be considered for evaluation. Note: The qualifying requirements data shall be enclosed with the technical bid only. The bidders who do not qualify this criterion, will be disqualified immediately and their bids will not be considered. 38. TECHNICAL BID The Technical Bid should be sealed in an envelope clearly marked in bold TECHNICAL BID FOR EMPANELMENT UNDER MUKHYAMANTRI AMRUTUM (MA) YOJANA written on the top of the envelope. If the Bidder fails to submit the supporting documents offline within time limit, he is liable for immediate disqualification. a. The online bid should be submitted on or before the time stipulated in the RFP notice at the web site b. The envelope should have the Bidder s name and address clearly written at the left bottom corner of the envelope. 39. FINANCIAL BID: The Financial Bid should be compulsorily submitted through online only. (Please note that Anexture-5 should be attached to Financial Bid only) 1. The Financial Bid shall take into account all costs associated with the assignment. 2. No other information shall be provided along with the Financial Bid. 3. The Financial Bid submission should be done on the website (electronic format) only on 4. The online bids should be submitted on or before the time stipulated in RFP notice at the website RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 27

28 The envelopes (Technical Bid) should be sealed and duly super-scribed. Technical Bid for empanelment under Mukhyamantri Amrutum (MA) Yojana. The Technical Bid with supporting documents in physical form should be submitted at the following address before the due date and time. Dr. B. K. Patel, Additional Director (FW), Commissionerate of Health and Family Welfare, MS and ME, Block No. 5, Dr. Jivraj Mehta Bhavan, Gandhinagar, Gujarat Phone: Fax: , No Bid will be accepted after the prescribed closing time for submission of the same. The delay will not be condoned for any reason whatsoever including network/postal/transit delay. However, if the last date for submission of Bids is declared as a holiday by the Government, the last date for submission of Bids will be extended to the next working day. The Bids may be cancelled and not evaluated if the Bidder: 1. Fails to submit the Financial Bid online; 2. gives incomplete Bids; 3. submits the technical and financial bids not as mentioned in the RFP Document; 4. Makes additions or deletions in the packages of Financial Bid; 5. If in the financial bid the Benefit Package rate does not includes the follow up charges. 40. DEADLINE FOR SUBMISSION OF BID/PROPOSALS: Complete Bid document should be uploaded to by hours on 19 th July, 2012 and physically submitted by hours on 19 th July, The Bid documents received later than the prescribed date and time will not be considered for evaluation. RFP FOR HOSPITAL EMPANELMENT UNDER MA YOJANA-GUJARAT Page 28