Rural Private Hospitals Association of Kenya (RUPHA) has announced the resumption of services under the Social Health Authority (SHA) insurance scheme.
In a statement on Thursday, the association said this follows the government’s pledge to clear the arrears owed to the defunct NHIF.
“After extensive deliberations, we have reached a decision to call off the boycott of SHA services, effective immediately,” RUPHA chairman Brian Lishenga said in a statement.
On Wednesday, State House announced plans to pay in full all hospitals claiming Sh10 million and below from the NHIF.
The amount, it said, will represent 91 per cent of all facilities that were contracted by the insurer.
It added that the remaining nine per cent of hospitals, with total claims of above Sh10 million, will be subjected to a verification exercise that should be completed within 90 days after which a payment plan will be agreed on.
Acknowledging that the directive does not fully resolve all concerns, RUPHA noted that this represents a critical first step in addressing the financial distress facing healthcare facilities.
The suspension of services under Medical Administrator Kenya Limited (MAKL) will however continue, Lishenga stated.
He said this is due to a complete lack of action on the part of MAKL in addressing the concerns raised by providers.
According to RUPHA, MAKL has not conducted any reconciliation of existing debt owed to providers, meaning hospitals cannot track what is due or outstanding and that it has not been issuing remittance advice for payments made to facilities.
The facilities suspended the service on February 24, citing unpaid NHIF arrears, an unworkable outpatient reimbursement model, and government inaction in addressing persistent challenges.
The association at the same time stressed that it will closely monitor the government’s actions to ensure full implementation of its commitments.
Lishenga said should it fail to honor the pledges, they will immediately reassess their position and reconvene members to deliberate on next steps, including the possibility of reinstating service suspension.
“If facilities owed over Sh10 million do not receive at least Sh10 million in upfront payments, we will escalate our engagement with Parliament to ensure that budgetary allocations are structured fairly,” he said.
On the claim verification process, the Lishenga warned that should it delay beyond 90 days, RUPHA will demand an urgent review and consider reinstating industrial action to push for immediate resolution.
He added: “If MAKL and its underwriters, Minet and CIC, do not take immediate action to address the issues raised, RUPHA will escalate the matter to regulatory authorities and legal channels to protect healthcare providers from exploitative financial practice.”
