Accreditation of Health Care Facility

·         A health care facility whose previous accreditation has lapsed

·         A health care facility which changes ownership

·         A health care facility that upgrades or downgrades its facilities

·         Teaching Hospitals

·         Regional Hospitals

·         District Hospitals

·         Quasi Public Hospitals (such as SSNIT, Police, etc.)

·         Mission Hospitals

·         Private Hospitals & Health Clinics

·         Health Centres

·         Dental Clinics

·         Maternity Homes

·         Pharmacies & Licensed Chemical sellers

·         Private Medical Diagnostic Facilities

·         Other facilities as the Council may prescribe

·         No, unless you have being issued a Certificate of Accreditation, you shall not provide health care services to NHIS members.

·         A claim by a healthcare facility for services rendered before the issuance of a Certificate of Accreditation to that provider shall be invalid.

·         Application for Accreditation shall be made in person at the National Health Insurance Council Secretariat/NHIC Regional Secretariat.

·         The Accreditation Process is grouped into four (4) stages:

·         Completion of Application Form

·         Examination of Application

·         Authentication and Verification of Requirements

·         Issuance of License of Accreditation

·         An application form is issued to an applicant who intends to provide a Health care Service under the National Health Insurance Scheme for completion and submission.

·         The Applicant can call at the Council Secretariat/Regional Secretariat for the form. The applicant will be educated on the Obligations and Requirements expected under the National Health Insurance Act (ACT650, 2003).

·         Applicant can be assisted to complete Application Form in the secretariat or Application Form could be taken away by the applicant, if he/she cannot

·         Provide all the required information.

·         Completed Application form and the attachments can be submitted to the Council Secretariat/Regional Secretariat.

o        The submitted application and attachments will be examined for  Completeness.

o        That is to ensure that:

·        All portions of the Application Form have been completed

·        All data and information are complete and consistent

·        The form has been endorsed

o        If information on Application Form is not complete and/or inconsistent

o        Assist/ask applicant to complete the Application Form properly.

o        If the Application Form and all attachments are in order,

·         It will be endorsed with stamp, signature, and date.

·         An acknowledgement Receipt will be Issued to the Applicant.

o       Otherwise, the application (with attachments) will be returned to applicant for correction and re-submission.

o        What do I require to successfully pass the Authentication and Verification process of the NHIS Accreditation stage.

·         The facility has been in operation for at least six months immediately before the application

·         The facility has a good record in the provision of health care

·         The facility has human resources, equipment, physical structures and other requirements as may be determined.

·         The facility has accepted Quality Assurance Standards & Program

·         The facility adopts the referral protocols

·         The facility is prepared to comply with the information system requirements, including regular transfer of information and reporting mechanisms

·         The facility has the capacity to maintain accurate records of

o        In patients or clients

o        Services rendered

o        Results from services

o        Complaints received from clients

o        Health expenditure on patients or client

·         The facility is willing and able to comply with all corrective actions directed by the Council to ensure quality health service.

·         The facility agrees to permit the Council or any person authorized by the council to:

·         Enter and inspect its premises and health facilities

·         Have access to inspect its medical, financial and other relevant records.

·         Check the authenticity of all submitted Documents (to be specified)

·         Verify the following specific accreditation requirements in respect of:

o        Hospitals & Ambulatory Surgical Clinics

o        Hospitals and ambulatory surgical clinics in addition to the requirements as a further condition for their accreditation must;

·         Show evidence of Approval from the Ministry of Health to operate.

·         Comply with the provisions of the Private Hospitals and Maternity Homes Act 1958 (No. 9) as amended and its Regulations.

·         Comply with the Ministry of Health’s approved guidelines

·         Have a confirmation that the member is in good standing of a national association of licensed hospitals

·        Community Based Health Planning and Services Community based health planning and services shall in addition to the requirements for accreditation; Show evidence that it can be organized or managed by members of the community for the purpose of improving the health status of the community through preventive, promotive and curative health services, Have an affiliation with at least one health care facility accredited by the Council, or have facilities that are necessary to provide for health services for its beneficiaries;