NRHM Odisha State Treatment Fund (OSTF) Application Procedure

Name of the Organization : Odisha Department of Health & Family Welfare
Type of Facility : Odisha State Treatment Fund OSTF
State : Odisha

Website : http://nrhmorissa.gov.in/OSTF/LoginOSTF.aspx

Odisha State Treatment Fund :
The Odisha State Treatment Fund will provide financial assistance to the poor patients who are suffering from life threatening disorders & diseases, for treatment of their major ailments. The financial assistance will be released to the Medical Institutions in which treatment has been/is being given to the patients.

Eligibility Criteria For Assistance Under OSTF :-
** It is applicable to persons below the poverty line, person with annual family income not exceeding Rs.40,000/- in rural area and Rs.60,000/- in urban areas. Either BPL card / AAY card or annual income certificate issued by concerned Tahasildar will be accepted for determining the eligibility.
** RSBY card holder is also eligible under this scheme.
** An unknown accident victim, patients duly referred from registered destitute home / orphanage / mental asylum / Child care Institutions are also eligible for assistance under the scheme subject to citing sufficient reason thereof for recommending the patient under the scheme.
** The Central Government / State Government / PSU employees are not eligible.
** Assistance will be available only to patients undergoing treatment as in-patient in any of the Govt./Empanelled private hospitals.

However this will not restrict :
i. Cancer patients from getting chemo in Govt. Day Care Centre without being formally admitted.
ii. Patients who have undergone kidney transplantation at Govt. Hospitals from getting post-operative care including supply of free medicines and investigation up to 6 months from the date discharge.

** Assistance will not be available for reimbursing the expenditure incurred by the applicant. The date of application seeking financial assistance should be during the course of treatment.
** Re-imbursement of medical expenditure already incurred for treatment / operation shall not be permissible.
** Diseases of common nature and disease for which treatment is available free of cost under other health programmes / schemes will not be covered.
** Assistance will normally not be provided where medical coverage under ESI, CGHS or any other scheme is available or where there is a provision for reimbursement of cost of medicine.
** Any person shall be assisted once in a financial year. Repeat assistance for the same ailment shall not be allowed in any case. However, this will not be a bar for receiving the treatment assistance in phased manner for diseases like Cancer, Collagen disease, Renal failure etc.

Diseases covered under the scheme :
The eligible patients will be provided assistance for treatment in specific life threatening diseases as mentioned at Annexure –D.

Where To Get Assistance :-
** The assistance will be available for treatment in all State Government Hospitals including the three Govt. Medical College & Hospitals, SVPPGIP (SishuBhawan), Cuttack and AHRCC, Cuttack.
** The assistance will be available in empanelled private hospitals (List enclosed as Annexure-C

Procedure for seeking financial assistance For treatment at private & other hospitals under “OSTF” :-
The eligible patients will not be admitted into empanelled private hospitals as a case of first entry. They must be referred from Govt. Medical College or by the CDMOs / CMOs as have been authorised by Govt. (Subject to modification from time to time)-Annexure- F.

The referral of the patients by the Government Hospitals will be subject to following conditions :-
i. On non-availability of the required treatment in the concerned Govt. Hospitals.
ii. Where the patient will have to wait inordinately to avail the treatment.
iii. On recommendation of a team headed by Superintendent/CDMO with at least 2 other faculty members/ Senior M.O.

Note :
** In emergency case (cardiac arrest, road accident etc.) patient will get himself admitted to the empanelled private hospital without being referred. However, the authority of private hospital will intimate such admission to DMET within 24 hours. On being satisfied that the patient was suffering from disease requiring immediate treatment, DMET will approve covering such patient under OSTF fold.
** The Private Hospitals on admission of the patients will provide the required treatment and claim the treatment cost from DMET, Odisha after discharge of the patient.
** The dues of the Private Hospitals will be cleared by the DMET, Odisha within one month from the date of receipt of the bill.
** Funds will be released in favour of Private Hospitals towards the treatment of eligible patients as per CGHS rate applicable to the city where the hospital is located or the actual cost of treatment whichever is less.

Quantum Of Assistance :
** OSTF will be a top up to RSBY. The patient will be covered under RSBY at the first assistance and where the amount of assistance required exceeds the limit of RSBY, the patient will be provided assistance under OSTF.
** Treatment cost so approved shall be within the upper limit of Rs.3.00 lakh (Rupees three lakh only).
** The sanction of Medical College & Hospital / Capital Hospital / RGH shall be limited to Rs.1.00 lakh per case. Where the quantum of assistance exceeds Rs.1.00 lakh, Superintendent of Medical College & Hospitals, Superintendent, SVPPGIP, Director, AHRCC with the approval of the Revenue Divisional Commissioner and CMO of Capital Hospital, BBSR and RGH, Rourkela with the approval of DMET, Odisha can sanction up to Rs.2.00 lakh. If the quantum of assistance exceeds Rs.2.00 lakh the case will be referred to Member Secretary (DMET, Odisha) of the Executive Body of the Society for consideration and approval.
** The sanction of District Head Quarters Hospitals shall be limited to Rs.30,000/- per case. Where the quantum of assistance exceeds Rs.30,000/- CDMO with the approval of the Collector-cum-District Magistrate concerned can sanction up to Rs.50,000/-.
** For assistance over and above Rs.3.00 lakh, approval of the Hon’ble Chief Minister, Odisha needs to be obtained.
** The cost of treatment in respect of a patient will be as per the actuals or the ceiling limit prescribed for different diseases under Central Government Health Scheme, whichever is less. The items not mentioned in CGHS package will be as per actuals which includes admissible amount like; investigations, cost of medicines, procedure charges, etc.