The Social Health Authority (SHA) has launched new tariffs for the Public Officers Medical Scheme Fund (POMSF) after successfully concluding talks with Level 5 and Level 6 hospitals. Chief Executive Officer Mercy Mwangangi confirmed in a recent statement that the authority expects all hospitals to implement these updated rates within the next 21 days.
This transition follows the requirements of the POMSF addendum, which mandates a thorough market analysis and official board approval after engaging with healthcare providers. These steps ensure that the pricing remains fair and sustainable for both the government and medical institutions.
“The Authority shall conduct a market analysis during the first three (3) months of the commencement of the POMSF Scheme and, following negotiations with healthcare facilities, provide final tariffs subject to approval by the SHA Board,” the statement indicates.
The POMSF offers a comprehensive medical safety net for civil servants, teachers, members of the disciplined services, and their families. This scheme ensures that public officers can access a wide range of inpatient, outpatient, and specialized medical treatments whenever they need care.
The Social Health Authority will integrate these updated tariffs into its claims system through a phased approach, categorized by hospital level and specific service packages. Following the successful talks with larger facilities, SHA now prepares to enter negotiations with Level 3 and Level 4 hospitals to further refine the market analysis.
These new rates aim to mirror current market realities and the actual operational costs hospitals face, ensuring that medical facilities receive fair reimbursement. The updates will overhaul how public officers access services and how the system handles claims submission, adjudication, and payments.
SHA confirmed that hospitals agreeing to the revised terms will continue to offer uninterrupted care under the approved benefit structures.
“Facilities that have accepted the negotiated tariffs will continue providing services to POMSF beneficiaries in line with the approved benefit package and agreed reimbursement terms,” the statement adds.
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