YSR AarogyaSri Cancer Treatment 5 Lakhs Ceiling Relaxed GO 141

YSR AarogyaSri Cancer Treatment 5 Lakhs Ceiling Relaxed GO 141. HM & FW Department – Dr. YSR Aarogyasri - Comprehensive Treatment and Support for patients with Carcinoma (Cancer) and Relaxation of Financial Ceiling of Rs.5.00 Lakhs (Five Lakhs only) for such patients – Orders –Issued. HEALTH, MEDICAL & FAMILY WELFARE ( I.1 ) DEPARTMENT G.O.Rt.No. 141 Dated:19.12.2019 . Government hereby order for relaxation of ceiling of Rs.5.00 Lakhs (Five Lakhs only) per family per one-year for treatment of cancer patients and accordingly permits Dr YSR Aarogya Sri Healthcare Trust to approve treatment for cancer patients even if the cost of treatment in a year exceeds the ceiling of Five Lakh Rupees. The CEO, AHCT is directed to ensure due diligence while sanctioning treatment protocols for cancer patients

YSR AarogyaSri Cancer Treatment 5 Lakhs Ceiling Relaxed GO 141

Read the following

• 1. From the CEO, Dr. YSR AHCT, A.P., Guntur, Letter No. Dr YSR AHCT/6174 /P&Cv(Tumour Board)/c2019, dated 04.12.2019.
• 2. From the CEO, Dr. YSR AHCT, A.P., Guntur, revised Letter No. Dr YSR AHCT/6174 /P&C (Tumour Board)/2019, dated 10.12.2019.

ORDER: 

1. In furtherance of the instructions of the Hon’ble Chief Minister that patients with cancer should receive comprehensive treatment and sustained support without any financial ceiling on the cost of treatment from diagnosis to remission and beyond, the Chief Executive Officer (CEO) of Dr YSR Aarogyasri Health Care Trust (AHCT) has submitted draft guidelines in the references first and second read above. The Government has carefully examined the proposals and hereby order that the following guidelines shall be followed by all concerned while providing treatment to the patients diagnosed with cancer, so that patient receives comprehensive and integrated treatment until remission and thereafter, including home visits by the health professionals.
2. 2. Accordingly, all Network Hospitals empanelled for Cancer treatment must establish a Board of Oncologists (‘Tumor Board’) for jointly charting comprehensive treatment pathway customised for every patient diagnosed with cancer. In case of ‘solid’ cancers, the Board will comprise of three specialist oncologists, one each from Surgical, Medical and Radiation Oncology disciplines. In case of ‘liquid cancers’ like Leukaemia, the Board shall include a Haematologist with at least five-year experience in treatment of Leukaemia and a medical oncologist. The objective is to make an integrated assessment of every patient diagnosed with cancer and prepare a comprehensive treatment protocol (clinical pathway) that would include all or some of the disciplines of oncology until full remission and support during the post-remission period.
3. 3. The treatment pathway shall also include psychosocial support to the patient as well as the immediate family members and care givers and effective palliative care to patients with advanced untreatable cancers. This would entail that every patient with suspected cancer would be thoroughly evaluated, accurately diagnosed and proper staging would be determined and comprehensive treatment protocol with time schedule would be determined while embarking on treatment. The comprehensive treatment pathway recommended by the Board of Oncologists will be submitted to the AHCT for review and pre-authorisation.
4. 4. The Dr YSR Aarogyasri Trust (AHCT) shall establish a Panel of eminent Oncologists who are not members of the Tumour Board of the Network Hospital submitting the proposal. This panel will be coordinated by the Director of Medical Education or Superintendent / Principal of Medical College that would review the proposed treatment pathway and either approve or recommend appropriate revisions as deemed fit. This would eliminate incomplete or inappropriate treatment and multiple pre-authorisation requests. The Trust will accord approval for the entire treatment plan recommended by its panel of Oncologists that should be adopted for management by the Network Hospital.
5. 5. The Network Hospital Oncology team must consider the advice of the AHCT and adopt the recommended management. If there is any disagreement between the recommendations of the AHCT and the Network Hospital Oncology team, the same shall be referred to the CEO., AHCT for further examination by another panel of oncologists and Director Medical Education / Superintendent or Principal of any Medical College to be decided by the CEO., AHCT. However, there shall be no delay in starting the treatment on the pretext of procedural delays. During the course of treatment, if there is any need for change in the approved treatment plan, same shall be discussed again by the Tumour Board and revised proposal shall be submitted to AHCT for review and approval. The orders shall be issued revising the list of admissible procedures for cancers separately.
6. 6. All empanelled Hospitals providing cancer care shall organise cancer awareness campaign and conduct screening camps in different locations at least once a month at a place to be decided jointly by the Commissioner of Health and Family Welfare (CH & FW) and CEO., AHCT. The CEO., AHCT and CH &FW shall assign a cluster of PHCs / CHC / Area Hospital to each Network Hospital undertaking treatment of oncology patients, so that within a year the hospital would screen all persons living in the service area of the Cluster. Main Cancers to be focused during screening camp include Cancer of Cervix, Breast, Head and Neck, etc. Further all such network hospitals should impart basic training to health functionaries working in the field, especially the PHC / CHC Medical officers and ANMs, in early detection and referral of patients with cancers and post-treatment follow-up in the service area of the health cluster. This shall be taken up in consultation with the DMHOs, DCHS, and Medical College Hospital Superintendent / Principal.
7. 7. The orders issued above, shall be effective February 01, 2020 and any Network Hospital that does not establish multidisciplinary panel of Oncologists / Haematologist (Tumour Board) by 01 February 2020, will not be considered for treatment of cancer patients under AHCT until remedial action is taken. The Network Hospitals shall provide comprehensive and integrated care to patients with cancer until remission and beyond as required. It shall also employ a full time Psychology Counsellor / Occupational Therapist to provide psycho-social support to the patient, care givers and family members.

1. 8. The Director of Medical Education is hereby instructed to establish one Palliative Care Unit with at least fifteen beds in every Government Medical College Hospital and equip the unit with palliative care professionals within three months of this order. He shall submit necessary proposals in this regard to the government within fifteen days. All Network Hospitals must refer untreatable / advanced stage cancer patients for palliative care to the Government Medical College Hospital in the district where the network hospital is located.
2. 9. The AHCT, in consultation with the Director Medical Education and reputed Oncologists / Haematologists are directed to prepare detailed treatment guidelines duly adopting and adapting NCCN, NICE, etc., guidelines. Until such standardised treatment protocols are prescribed, the existing guidelines will continue to be in operation. The Government will review these treatment pathways once a year or as frequently as required and update them in harmony with the national and international cancer treatment pathways /protocols.
3. 10. The CEO., Dr YSR Aarogyasri Trust shall establish Cancer Registry with immediate effect in consultation with the Director of Medical Education, Commissioner APVVP, and CH &FW and shall be responsible for updating it in real time. The Registry shall include all cases of cancer reported in the state, including those not covered under the current guidelines of Dr YSR Aarogya Sri.
4. 11. Further, Government hereby order for relaxation of ceiling of Rs.5.00 Lakhs (Five Lakhs only) per family per one-year for treatment of cancer patients and accordingly permits Dr YSR Aarogya Sri Healthcare Trust to approve treatment for cancer patients even if the cost of treatment in a year exceeds the ceiling of Five Lakh Rupees. The CEO, AHCT is directed to ensure due diligence while sanctioning treatment protocols for cancer patients.