Government of Karnataka SUVARNA AROGYA …

1 1 Government of Karnataka SUVARNA AROGYA suraksha trust ( department of Health & family welfare ) memorandum OF understanding Rastriya Bala Swastya Karyakram (RBSK) Secondary Care Between SUVARNA AROGYA suraksha trust And Network Hospitals 2 CHECK LIST FOR SAST SCHEMES Name of the Hospital_____ 1. Two sets of MoU printed on white paper. First page should be on Rs. 100/- bond paper (2 sets Original) spiral binding 2. Every page of MoU should be signed by the authorised official of the hospital. 3. DD and Authorization letter to be submitted. Name of the Bank_____DD NO_____ Sl. No. Details Page No. Schemes approved 3 Table for specialities approved for the hospital 3 Day and Month of MoU 4 Name of the hospital and Postal address of the hospital 5 MoU signed and applicable for Provider Name (Hospital name), Authorized Signatories name signature with seal name 1 and Witness name signature RBSK 7 Specialties for which Empanelment is done and empanelled doctors details 17 Name of the services of Medical Officer (MO)/ Chief Medical Officer (CMO)/ Medical Superintendent (MS) 1 & 2 Telephone no.

2 Mobile no. and Email Id 20 Annexure - 4 (Tie-up details for CT, MRI and Blood Bank) 37 Name of the Hospital, Complete address, Affix the photo of KIOSK situated in hospital 45 Hospital Name, Name of the Bank, Account number, Branch details and IFSC code (with cancellation cheque) 58 RBSK Secondary care Benefit package applicable as per SAST online 41 3 Schemes approved: Secondary Care Schemes: Sl. No. Schemes Empanelment valid upto: Date 1 RASHTRIYA BALA suraksha KARYAKRAM (Central Government scheme for children from 0-18 years) TABLE FOR SPECIAITIES APPROVED FOR THE HOSPITAL Sl. No. Specialty Specialties taken (YES/NO) Additional specialties applied for, if any 1 Dental 2 ENT 3 OBG 4 Orthopedics 5 General Surgery 6 Ophthalmology 7 General Medicine 8 Endoscopic Procedures 9 Hysteroscopic Procedures 10 Paediatrics 11 Urology 12 Endocrine 13 Investigation procedures 4 memorandum OF understanding SuvarnaArogyaSuraksha trust (SAST) This Agreement made at Bangalore this _____ day of _____2017 between SuvarnaArogyaSuraksha trust (SAST)

3 , a trust incorporated under the Indian Trusts Act, 1882 and having its Registered Office at Bangalore Metropolitan Transport Corporation, TTMC A Block, 4th Floor, Shantinagar, KH Road, Bangalore - 560 027 hereinafter referred to as 5 " trust , which expression shall unless it is unacceptable to the context or meaning thereof shall deem to mean and include its successors and assignees of the ONE PART. AND _____ And having its establishment at _____ Hereinafter referred to as PROVIDER which expression shall unless it is unacceptable to the context or meaning thereof be deemed to mean and include its successors and assignees of the OTHER PART. WHEREAS, trust is an independent nodal agency established by the Government of Karnataka , providing health care to the identified beneficiaries, through SuvarnaArogyaSuraksha (SAST) throughout the State for specified surgeries / therapies.

4 SAST is implementing Vajpayee Arogyashree for BPL beneficiaries and JyothiSanjeevini for State Government Employees and their dependents on Cashless basis and Rajiv ArogyaBhagya for APL beneficiaries with co-payment, Senior Citizen Scheme to cover illnesses in persons who are of age 60 years or above, belonging to a RSBY beneficiary family . All other senior citizens who do not have RSBY card but have BPL card would also be covered. Indira SurakshaYojane provides treatment to dependent family member of farmers who have committed suicide on a public private partnership model, empaneling both public and private hospitals forming a network of service providers. National Health Mission in their letter dated addressed to Yashswini trust mentioned that it has been decided to entrust Tertiary care services under RashtriyaBalaSwasthyaKaryakram to SAST with effect from 1st of November 2014 and marked copy of the same to SAST.

5 Accordingly SAST has been providing Tertiary care services to RBSK beneficiaries with effect from 1st of November 2014 Subsequently in the meeting conducted under chairmanship of Principal Secretary to Government Health and family welfare department held on , it is decided to provide Secondary care treatment under RBSK through hospitals empanelled by Yashswini trust . Now the implementation of RBSK secondary care services will be taken care by SAST through its RSBY empanelled Government Network hospitals from April 2017 as per MoU dated with NHM 6 National Health Mission pays special attention for reduction of mortality rate of mothers and children. Of the 100 children who take birth, 6-7 born with defect at birth and 10% of the children have developmental delays.

6 The objective of the scheme Rastriya Bala Swasthya Karyakram is early detection and management of such 4D s namely Defects of Birth , Diseases in Children, Deficiency conditions and Development delays including disabilities. The scheme aims to service all the children from 0-6 years of age in rural areas and urban slums and also from 06 to 18 years of age for the children enrolled in class 1- 12 in Government and Government aided schools. Beneficiaries need to procure the referral letter by the Administrative Health office or Taluk Health Officer or District Health Officer. Children can also be treated without referral letters through VAS camps, for walk-in children BPL card is mandatory. The Package amount is Rs 30000/- per family , per year.

7 The package rates are the maximum rate indicated for each surgical procedure as mentioned in Annexure (VI) _____ desires to join the said network of Providers and is willing to extend cashless basis, medical care to the beneficiaries of SAST. 7 MoU is signed and applicable for:- RBSK Secondary Care: Signed and delivered by within named: Date: Provider: _____ Through Sri/ Sign _____ In presence of Sri/ Smt. _____Sign_____ SAST: Executive Director_____Sign_____ Director (MM) _____Sign _____ 8 A. About SAST SuvarnaArogyaSuraksha trust (SAST) is a trust under the department of Health and family welfare , established as a special purpose vehicle to implement Government health schemes in an efficient and effective manner in 2009.

8 The various schemes are implemented through a PPP model with public and private hospitals that are empanelled under SAST. The various schemes implemented by SAST are for Tertiary care and Secondary care. The hospitals are empanelled through the SAST online platform, if they meet with the empanelment criteria for the different schemes ad specialities. Currently hospitals are empaneled throughout the state and also the neighbouring states of Maharashtra and Andhra Pradesh and Telangana, for the population of the northern Karnataka districts. Now this agreement witnessed as under: Article 1: Definitions trust : SUVARNA AROGYA suraksha (SAST) BPL : Below Poverty Line families as defined by the department of Food, Civil Supplies & Consumer Affairs, Government of Karnataka .

9 RBSK Beneficiary : The scheme aims to service all the children from 0-6 years of age in rural areas and urban slums. From 06 to 18 years of age for the children enrolled in class 1- 12 in Govt. and Govt. aided schools Eligibility: Children of 0-6 years of age in rural areas and urban slums and from 6-18 years of age for the children enrolled in classes 1st to 12th in Govt. and Govt. aided schools are eligible under the scheme. Beneficiaries need to procure the referral letter by the Administrative Health office or Taluk Health Officer or District Health Officer. Children can be treated without referral letter through VAS camps and also for walk-in children BPL card is mandatory. Network Hospital (NWH) : Government Hospital empanelled under RSBY Scheme MOU : memorandum of understanding between the trust & Empanelled Hospital.

10 Surgery/Surgeries : means cutting, abrading, suturing, laser, laparoscopic or otherwise physically changing body tissues and organs by qualified medical doctor who is authorized to do so. Therapy/Therapies : Specific way of medical treatment to the beneficiaries before/after surgery. 9 Treatment : Medical management by qualified Doctor/s in the Network Hospital Medical Officer (MO)/ Chief Medical Officer (CMO)/ Medical Superintendent(M/S) : Doctor from the Empanelled Hospital withat least MBBS qualification, to coordinate with the trust Communication : All official correspondence between the SAST and the NWHshall be through the Medical Officer (MO)/ Chief Medical Officer (CMO)/ Medical Superintendent (MS)E-mail ID issued by theTrust.