South Africa National Health Insurance Act 20 of 2023
Chapter 8: operation of the Fund, medical schemes, procurement, accreditation, information and payment – South Africa National Health Insurance Act 20 of 2023

South Africa National Health Insurance Act 20 of 2023 39-2: Accreditation requirements: professional registration, OHSC certification and the performance criteria

What does 39-2 require?

Accreditation by the Fund requires a provider or establishment to hold, and show, registration with a recognised statutory health professional council and OHSC (Office of Health Standards Compliance) certification, and must meet users' needs and comply with the prescribed performance criteria, supported by a budget impact analysis: offering at least the gazetted minimum range of personal health services, staffing with the right number and mix of professionals under the published guidelines, keeping to treatment protocols (including Formulary prescribing and procurement), following the referral pathways, feeding data into the national health information system, and keeping to the national pricing regimen (section 39(2)). The Fund then concludes a binding contract stating performance expectations for patient management, volume, quality and access (section 39(3) and (4)), and providers must be accredited before they are reimbursed (section 41(2)).

Maintained by Gerard Blokdyk

Other controls in Chapter 8: operation of the Fund, medical schemes, procurement, accreditation, information and payment – South Africa National Health Insurance Act 20 of 2023

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