Office of Senior State Medical Commissioner - … PUNJAB final 2016.pdf · Office of Senior State Medical Commissioner ... iii. The hospitals, which are not NABH accredited may be

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Office of Senior State Medical Commissioner EMPLOYEES’ STATE INSURANCE CORPORATION

{Ministry of Labour & Employment (Govt. of India)}

Regional Office, Madhya Marg, Sector 19-A, Chandigarh

================================================= No. PB/12/10/SMC/tie up Arrangement/2016 Dated: 27.12.16

DOCUMENT COST RS 1000/-(Non Refundable)

EXPRESSION OF INTEREST (EOI)

(Please read all terms and conditions carefully)

State Medical Commissioner ,ESIC, Punjab, Chandigarh invites Expression of Interest from

CGHS Empanelled / State Govt. Empanelled /Any PSU Empanelled Hospitals for

Empanelment of Hospitals for Superspecialty treatment. This empanelment is for patients

being referred from ESIS Hospitals, Punjab on cashless basis at applicable CGHS Rates for

this region (given at its website) / ESIC Rates in sealed envelope. Application forms along with

Terms and conditions can be obtained from the office of State Medical Commissioner from

29/12/2016 on any working day up to 23/01/2017 Application forms along with terms and

conditions can be downloaded from the website “www.esicpunjab.org and www.esic.nic.in

.Duly filled in forms, complete in all respect should reach the office of State Medical

Commissioner by 24/01/2017 upto 11.00AM. EOI will be opened on 24/01/2017 in the office

of State Medical Commissioner at 2.30 PM. If EOI opening date happens to be a holiday, it

will be opened on next working day. Applicant/authorized person may choose to be present at

the time of opening of EOI.

Document Acceptance: EOI Documents may be dropped either in tender box or may

be sent by Registered post only in sealed envelope. Documents received by Ordinary

post/ courier/ any other means will not be accepted at all. Document received after the

scheduled date and time will be rejected out rightly and State Medical Commissioner will

not be responsible for any postal delay.

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TERMS AND CONDITIONS

(Please read all terms and conditions carefully before filling the application form and

annexures thereto)

EOI Document Cost:

The cost of EOI document is Rs. 1000/- (Rupees One thousand Only) non-refundable

which is payable in the form of a Demand Draft drawn on any nationalized/ Scheduled

bank in favour of “ESIC fund Account No-1”payable at Chandigarh. Party downloading

the form from website must submit this Demand Draft in original along with EOI

documents in sealed envelope.

Document Acceptance:

Duly completed EOI forms along with annexures and necessary documents may either

be dropped in person in the tender box kept at The Office of State Medical

Commissioner or be sent by Registered Post at the address mentioned below. The

sealed envelope should be super-scribed as “EOI for empanelment of Hospitals for

Super Specialty Treatment for ESIS Hospitals Punjab”. Documents received after

the scheduled date and time (either by hand or by post) or open EOI or EOI received

though e-mail/fax or without original demand draft will summarily be rejected.

Condition for opening of EOI:

1. Please ensure that each page of the EOI is downloaded and is submitted in Toto

With each page signed and stamped by the signatory authority.

2. The each page of the EoI should be serially numbered, signed by the signatory

Authority.

3. EOI Document will be out rightly rejected if any technical condition is not fulfilled.

4. Photocopy of necessary certificates (as mentioned below) should be attached

With EoI.

Performance Bank Guarantee (PBG):

Hospitals recommended for empanelment after the initial assessment, shall have to

furnish a Performance Bank Guarantee of Rs. 2 lac (rupees two lacs only), valid for a

period of 30 months that is six months beyond the period of empanelment to ensure

efficient services and to safeguard against any default.

Tie-Up agreement:

The applicants who fulfill all the criteria laid down in the EOI document and selected for

empanelment will have to sign MOU with the State Medical Commissioner, Punjab and

Chandigarh.

Period of Empanelment:

The empanelment shall be initially for a period of two years which may be extended for a

period of one year by mutual consent.

Proposal for empanelment may be sent to office of State Medical Commissioner,

Regional Office, ESI Corporation, Panchdeep Bhawan, Plot No.3, Madhya Marg,

Sec. 19-A, Chandigarh.

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The State Medical Commissioner, Punjab reserves the rights to accept/ reject one or all

of the applications without assigning reasons thereof.

Conditions for Empanelment:

1. Hospitals empanelled by CGHS will be considered for empanelment by State Medical

Commissioner, Punjab. Such Hospital should attach copies of valid empanelment letter

from CGHS. Concerned Hospital should also submit list of empanelled specialties by

CGHS

2. If CGHS empanelled hospitals are not available or inadequate, then State Govt.

empanelled Hospitals, will be considered for empanelment. Such Hospital should attach

copies of recent approval letter from State Govt. Concerned Hospital should also submit

list of approved specialties by State Govt.

3. If neither the CGHS nor State Govt. empanelled hospitals are available or are

inadequate in number, then hospitals which are empanelled by any PSU will be

considered for empanelment. Such hospitals should attach copies of recent approval

letter from PSU. Concerned Hospital should also submit list of empanelled specialties by

PSU.

4. There may be some areas where none of health care organization is approved by any of

the above mentioned agencies, in such situation the empanelment shall be done by

inviting applications from health care organizations through advertisements. If

none/inadequate number of health care organization qualify the CGHS criteria, then

selection will be based on the relaxed criteria with inspection. The approval of the

relaxed criteria will be obtained from the competent authority.

The relaxed criteria may be:-

a) Annual turnover

b) Total number of operational beds

c) Duration for which health care is providing services

d) Any other criteria without affecting the quality of services

5. Maximum 5(five) Hospitals will be empanelled for an ESIS Hospital, for super specialty

treatment in such a manner that each discipline of superspecialty should be available in

minimum two tie up hospitals.

6. Preference will be given to :

(i) CGHS empanelled hospitals followed by State Govt. empanelled followed by

PSU empanelled hospitals.

(ii) Hospitals having more number of empanelled super specialty branches.

(iii) Hospitals situated nearer to ESIS Hospital.

(iv) While evaluating the EoI, at least one hospital of each super specialiality branch

which is near to ESIS Hospital, will be preferred.

7. Criteria for empanelment of Hospitals:

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i. The Health Care Organizations should preferably be accredited by National

Accreditation Board for Hospitals & Healthcare Providers (NABH).

ii. However, the hospitals which are not accredited by NABH may also apply for

empanelment but their empanelment shall be provisional till they get NABH

accreditation, which must preferably be done within a period of six months but not

later than one year from the date of their empanelment.

iii. The hospitals, which are not NABH accredited may be empanelled provisionally on the

basis of fulfilling the criteria and submission of an affidavit that the information

provided has been correct and in the event of failure to get recommendation from

NABH, which must preferably be done with in a period of six months but not later

than one year of their empanelment, the empanelled hospital shall forego 50% of the

Performance Bank Guarantee and its name would be removed from the panel of

ESIC.

iv. ESIC also reserves the right to prescribe/revise rates for new or existing treatment

procedure(s)/investigation(s) as and when CGHS revises the rates, or otherwise.

v. Scanned Copies of all the documents mentioned in the criteria for empanelment

Annexure-IV.

vi. The Health Care Organization must have been in operation for at least one full financial

year. Copy of audited balance sheet, profit and loss account for the preceding

financial year (2014-15) to be submitted (attach copy).

vii. Copy of NABH Accreditation in case of NABH accredited Hospitals (Attach copy).

viii. Copy of NABH application in case of Non – NABH accredited hospitals (Attach

copy).

ix. Non NABH hospitals that have not applied for NABH attach undertaking.

x. List of treatment procedures/investigations/facilities available in the Health Care

Organization (Attach copy).

xi. State registration certificate/Registration with Local bodies, wherever applicable (Attach

copy).

xii. Compliance with all statutory requirements including that of Waste Management.

xiii. Fire Clearance Certificate/Certificate by authorized third party regarding the details of

Fire safety mechanism as in place in the Health Care Organization (Attach copy).

xiv. Registration under PNDT Act, for empanelment of Ultrasonography facility (Attach

copy).

xv. Certificate of Undertaking as per the Annexure-III

xvi. AERB approval for tie-up for radiological investigations/Radiotherapy, wherever

applicable (Attach copy).

xvii. Certificate of Registration for Organ Transplant facilities, wherever applicable.

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xviii. The Health Care Organization must have the capacity to submit all claims / bills in

electronic format to the ESIC / ESIS system and must also have dedicated

equipment, software and connectivity for such electronic submission.

xix. The Health Care Organization must give an undertaking accepting the terms and

conditions spelt out in the Memorandum of Agreement, which will be read as part of

this document.

xx. The Health Care Organization must certify that they shall charge as per CGHS rates /

ESIC rates and that the rates charged by them are not higher than the rates being

charged from their other patients who are not ESI Beneficiaries.

xxi. The Health Care Organization must certify that they are fulfilling all special

conditions that have been imposed by any authority in lieu of special concessions

such as but not limited to concessional allotment of land or customs duty exemption.

xxii. The Health Care Organization must agree for implementation of EMR/EHR as per

the standards notified by Ministry of Health & Family Welfare within one year of their

empanelment.

xxiii. The Health Care Organizations must have minimal annual turnover of Rs.1 Crore.

xxiv. Photo copy of PAN Card

xxv. Bank Details.

xxvi. MINIMUM NUMBER OF BEDS REQUIRED

i. Metro cities (except Mumbai) …………………….. …………….………50 (Mumbai – the case is sub-judice in Mumbai High Court)

ii. Other cities …………………………………………………………….…30

NB: The number of beds as certified in the Registration Certificate of State Government/Local

Bodies/NABH/Fire Authorities shall be taken as the valid bed strength of the hospital. (Attach

copy)

: CGHS / State Govt. / Public Sector Undertakings/ empanelled hospitals having minimum bed

strength mentioned above will only be considered for empanelment.

XXVI. If need arises, MS of the ESI Corporation Hospital may also do tie up arrangement for

secondary care, preferably with same multi/super specialty hospital attached to it.

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Annexure: 1

Empanelled centre should mention clearly in Yes/No format regarding super specialist services

for which they want to be empanelled from the list mentioned below:-

The scope of services to be covered (Yes/No)

1. Any treatment rendered to the patient at a Tertiary centre / Superspeciality hospital

by a Superspecialist. ( )

2. Cardiology ( )

3. Neurology ( )

4. Oncology and ( )

5. Urology / Nephrology ( )

6. Gastroenterology and ( )

7. Endocrinology ( )

8. Burns and Plastic Surgery ( )

9. Cardiothoracic Vascular surgery ( )

10. Neurosurgery ( )

11. Oncosurgery ( )

12. Urosurgery/ Nephrosurgery ( )

13. GI surgery ( )

Signature of authorized signatory

The Scope of Super Specialty Investigations (SSI) to be covered

1. CT Scan ( )

2. MRI ( )

3. PET Scan ( )

4. Echocardiography ( )

5. Specialized Biochemical Investigations. ( )

( Tumor Markers, Immunohistochemistry, Hormonal Assay

And PCR based tests, Electrophoresis, coagulation profile)

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Annexure - II

APPLICATION FORMAT FOR EMPANELMENT OF HOSPITALS

1. Name of the city where hospital is located.

2. Name of the hospital

3. Address of the hospital

4. Nearest ESIS hospital.

5. Distance from Nearest ESIS Hospital (in Km.)

6. Tel / fax/e-mail

Telephone No

Fax

e-mail address

Name and Contact details of Nodal persons

Whether CGHS empanelled (attach proof)

Whether State Govt. empanelled (attach proof)

Whether Public Sector undertaking

empanelled (attach proof)

Whether NABH Accredited (attach proof)

Whether NABH applied for (attach proof and

give undertaking)

For non NABH (give undertaking)

Details of Accreditation and Validity period

a. Details of the application fee draft of Rs. 1000/- (non refundable)

Name & Address of the Bank DD No. Date of Issue

b. Total turnover during last financial year : -

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(Certificate from Chartered Accountant is to be enclosed).

6. For Empanelment as Hospital for all available super specialty facilities

(Enclose list)

7. Total Number of beds

8. Categories of beds available with number of total beds in following type of wards

Casualty/Emergency ward

ICCU/ICU

Private

Semi-Private (2-3 bedded)

General Ward bed (4-10)

Others

9. Total Area of the hospital

Area allotted to OPD

Area allotted to IPD

Area allotted to Wards

10. Specifications of beds with physical facilities/ amenities

Dimension of ward Number of beds in each ward

Length Breadth (Seven Square Meter Floor area per bed required-) (IS: 12433-Part 2:2001)

11. Furnishing specify as (a), (b), (c), (d) as per index below

(a) Bedside table

(b) Wardrobe

(c) Telephone

(d) Any other

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12. .Amenities specify as (a), (b) (c) (d) as per index below Amenities

(a) Air conditioner

(b) T.V.

(c) Room service

(d) Any other

13. Nursing Care Total No. of Nurses

No. of Para-medical staff

Category of Bed/Nurse Ratio (acceptable Actual bed/nurse standard) ratio

High dependency Unit 1:1

14. Alternate power source Yes/No

15. Bed Occupancy Rate

General Bed -

Semi – Private Bed -

Private Bed -

16. Availability of Doctors

1. No. of Full Time / Part time Doctors -

2. No. of Full Time / Part time Specialists / Consultants -

17. Laboratory facilities available – Pathology, Biochemistry,

Microbiology or any other

18. Imaging facilities available -

19. No. of Operation Theaters -

20. Whether there is separate OT for Specific cases Yes/No

21. Supportive services

Boilers / Sterilizers

Ambulance

Laundry

House keeping

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Canteen

Gas Plant

Dietary

Blood Bank/ Blood storage

Pharmacy

Physiotherapy

22. Waste disposal system as per statutory requirements.

23. ESSENTIAL INFORMATION REGARDING CARDIOLOGY

Number of Specialist

Qualification Of specialist. (Attach Copies)

Number Of coronary angiograms done in last one year

Number of Angioplasties done in last one year

Average Daily OPD in cardiology

Specific equipments related to Cardiology available in hospital.

24. ESSENTIAL INFORMATION REGARDING NEUROLOGY



Number Of coronary angiograms done in last one year

Number of EEG’s done in last one year

Average Daily OPD in Neurology

Specific equipments related to Neurology available in hospital.

25. ESSENTIAL INFORMATION REGARDING ONCOLOGY

Number of Specialist – Medical/ Surgical/ Radation


Number Of Onco Surgries done in last one year

Number of Chemotherapy patients in last one year

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Is Day care Chemotherapy ward available

Radiation facility- Number and type Of units installed

Average Daily OPD (Cancer Patients)

Specific equipments related to Oncology available in hospital.

26. ESSENTIAL INFORMATION REGARDING UROLOGY/NEPHROLOGY



Number Of Dialysis Units

Number of dialysis done on average in one month.

Average Daily OPD in UROLOGY/NEPHROLOGY

Specific equipments related to nephrology available in hospital.

27. ESSENTIAL INFORMATION REGARDING GASTROENTEROLOGY



Number Of interventions done in last one year

Number of endoscopies and colonoscopies done in last one year

Average Daily OPD in Gastroenterology

Specific equipments related to Gastroenterology available in hospital.

28. ESSENTIAL INFORMATION REGARDING ENDOCRINOLOGY



Average Daily OPD in Endocrinology

Specific equipments related to Endocrinology available in hospital.

29. ESSENTIAL INFORMATION REGARDING CTVS



Number of open heart surgeries done in last one year

Number of CABG done in last year

Other Surgical procedures done in last one year

Average Daily OPD in CTVS

Specific equipments related to CTVS available in hospital.

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30. ESSENTIAL INFORMATION REGARDING NEUROSURGERY



Number Of surgical procedures done in last one year

Average Daily OPD in Neurosurgery

Specific equipments related to Neurosurgery available in hospital.

31. ESSENTIAL INFORMATION REGARDING PEDIATRIC SURGERY



Number Of Pediatrics Surgeries performed in last one year

Average Daily OPD in Pediatrics Surgery

Specific equipments related to Pediatrics Surgery available in

hospital.

32. ESSENTIAL INFORMATION REGARDING GI SURGERY



Number Of Surgical Procedures done in last one year

Average Daily OPD in GI Surgery

Specific equipments related to GI Surgery available in hospital.

33. ESSENTIAL INFORMATION REGARDING BURNS AND PLASTIC SURGERY



Number Of Surgical Procedures done in last one year

Average Daily OPD in plastic Surgery & Burns

Is there a separate ward for burns patients

Specific equipments related to plastic Surgery & Burns available in

hospital.

34. RENAL TRANSPLANTATION, HAEMODIALYSIS/ UROLOGY- UROSURGERY

Number of Renal Transplantations done during last one year

Number of years this facility is available

Number of Hemodialysis unit.

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Criteria for Dialysis:

The center should have good dialysis unit neat, clean and hygienic like a minor OT. Yes/No Centre should have at least four good Haemodialysis machines with facility of giving

bicarbonate Haemodialysis. Yes/No Centre should have water-purifying unit equipped with reverse osmosis. Yes/No Unit should be regularly fumigated and they should perform regular antiseptic precautions.

Yes/No Centre should have facility for providing dialysis in Sero positive cases. Yes/No Centre should have trained dialysis Technician, Nurses, full time Nephrologist and Resident

Doctors available to manage the complications during the dialysis. Yes/No Centre should conduct at least 150 dialysis per month and each session of hemodialysis

should be at least of 4 hours duration. Yes/No

Facility should be available 24 hours a day.

If so, does it exist within the city where the hospital is located

Yes / No -

Whether it has blood transfusion service with facilities for screening HIV markers for Hepatitis (B & C), VDRL

Yes / No -

Whether it has a tissue typing unit DBCA / IMSA / DRCG scan facility and

the basic Radiology facilities

Yes / No -

35. Oncosurgery

I. Whether the hospital has aseptic Operation theatre for Oncology – Surgery

Yes / No

a. Whether, it has required instrumentation for Oncology Surgery

Yes / No

II. Facility for Chemotherapy – specify details

Yes / No

III. Facilities for Radio – therapy (Specify)

Yes / No

IV. Radio – therapy facility and manpower shall be as per guidelines of BARC

Yes / No

V. Details of facilities under Radiotherapy :

SIGNATURE OF APPLICANT OR AUTHORIZED AGENT

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Annexure - III

CERTIFICATE OF UNDERTAKING

1. It is certified that the particulars given above are correct and eligibility criteria are satisfied.

2. That Hospital shall not charge ESI beneficiaries higher than the CGHS notified rates or the

rates charged from other patients who are not ESI beneficiaries.

3. That the rates have been provided against a facility/procedure/investigation actually

available at the Organization.

4. That if any information is found to be untrue, Hospital would be liable for de-recognition by

ESI. The Organization will be liable to pay compensation for any financial loss caused to

ESI or physical and or mental injuries caused to its beneficiaries.

5. That the Hospital has the capability to submit bills and medical records in digital format

and that all Billing will be done in electronic format and medical records will be submitted in

digital format.

6. The Hospital will pay damage to the beneficiaries if any injury, loss of part or death occurs

due to gross negligence.

7. That the Hospital has not been derecognized by CGHS or any State Government or other

Organizations.

8. That no investigation by central Government/State Government or any statutory

Investigating agency is pending or contemplated against the Hospital.

9. Agree for the terms and conditions prescribed in the tender document.

10. Hospital agrees to implement Electronic Medical Records and EHR as per the standards

approved by Ministry of Health & Family Welfare within one year of its empanelment

11. Non NABH hospitals will get NABH accreditations preferably within a period of six months

but not later than one year from the date of their empanelment. Failing to do so, ESIC can

deduct 50% of the performance bank guarantee and its name can be removed from the

empanelment.


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Annexure - IV

Scanned Copies of the following documents (wherever applicable) are to be submitted

along with the EOI

1. Copy of legal status, place of registration and principal place of business of the health

care Organization or partnership firm, etc.,

2. A copy of partnership deed/memorandum and articles of association, if any

3. Copy of Customs duty exemption certificate and the conditions on which exemption was

accorded, if any.

4. Copy of the license for running Blood Bank.

5. Copy of the documents full filling necessary statutory requirements including waste

management.

6. Copy of valid empanelment letter of CGHS/ State Govt. / Public Sector Undertakings.

7. Copy of NABH accreditation, if NABH accredited.

8. For non NABH, copy of application along with undertaking

9. For non NABH, (not applied) copy of undertaking

10. Copy of Proof of number of beds as certified by registration certificate of State

Govt./Local bodies/NABH/Fire authorities.

11. Tender document complete in all respect with each page serially numbered, signed and

stamped by the authorized signatory.

12. Demand draft of Rs. 1000/- in original (non refundable)

13. Copy of PAN Card

14. Copy of bank details

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15. Copy of audited balance sheet, profit and loss account for the preceding financial year

(2014-15) to be submitted (attach copy).

16. List of treatment, procedures, investigation and specialities available in the hospital.

17. Copy of Fire Clearance Certificate/Certificate by authorized third party regarding the

details of Fire safety mechanism as in place in the Health Care Organization (Attach

copy).

18. Copy of Registration under PNDT Act, for empanelment of Ultrasonography facility

(Attach copy), if applicable.

19. Proof of minimal annual turnover of Rs.1 Crore .
