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TMI Blog2019 (10) TMI 1185X X X X Extracts X X X X X X X X Extracts X X X X ..... the 'Applicant is a poly clinic run by the partnership firm M/s. Shifa Hospitals with PAN No. AAUFS1477M and are not registered under GST Act. They provide health care services to both out-patients and in-patients. The applicant has sought advance ruling on the following question:- Whether the medicines, consumables and implants used in the course of providing health care services to in-patients for diagnosis or treatment would be considered as "Composite Supply" and accordingly eligible for exemption under the category "HEALTH CARE SERVICES"? The applicant has submitted the copy of application in Form GST ARA - 01 and also submitted a copy of Challan evidencing payment of application fees of Rs. 5,000/- each under sub-rule (1) of Rule 104 of CGST rules 2017 and TNSGST Rules 2017. 2. The applicant has stated that they are providing health care services to both out-patients and in-patients. In-Patients are those who are admitted in to the hospital for their diagnosis and treatments. The in-patients are provided with the facilities like stay inside the hospital rooms, diagnosis services, treatments including surgical treatments, post-surgery treatments, medicines, consumables, im ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... ent practice for in-patient. In future, they intend to supply all medicines implants, consumables in-house without asking the patients to buy for outside pharmacies. They undertook to further submit the invoices alongwith write-up in 2 weeks' time. 3.1 The applicant submitted the documents (attached in serially numbered order) supporting the full sequence of admissions, diagnosis, and treatments etc. along with the billing of the same for a sample IP case as under:- 1. On the admission of the patient as IP a general consent form duly signed by the care taker of the patient is taken. 2. A billing card is maintained recording all the details of visits and diagnosis by doctors, various types of treatments including surgeries, post-operative treatments etc., given to the IP patient. 3. Doctors' daily progress report containing details of prescriptions of tests and medicines and other care to be undertaken. 4. A drug chart maintained at the wards/rooms having details of drugs given to the patients (the drugs which are procured by the care takers from outside the hospitals) during their stay as Inpatients. 5. Investigation chart prepared during the course of various tests done ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... s to both out-patients and in-patients. Presently they do not have an in-house pharmacy. The medicines required to be administered for the in-patients are purchased by the patients from Shifa Pharmacy which is a separate entity. As seen from the submissions (bills), the applicant bills the in-patients for the Room charges, Nursing charges, lab investigation charges while medicines, consumables, etc are not charged in the hospital bill. The applicant has stated in their letter submitted after PH, that presently they do not charge anything for the medicines as the medicines prescribed by the hospital is procured by the patients outside the hospital; that the consumables, implants, etc which are essentials for the treatments at operation theatres/ICU wards/post operation wards, etc are supplied during the course of such treatment by the hospital itself and is billed at the time of discharge. The applicant has further stated that to minimize the time lapse in diagnosis and treatment and hardships undergone by the patients and their caretakers in the current practice, they intend to procure and store the medicines in addition to the consumables, implants, etc in the name of the hospital ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... 32/06/2018-GST dt 12.02.2018 which is given below: 5(2) Retention money: Hospitals charge the patients, say, Rs. 10000/- and pay to the consultants/ technicians only Rs. 7500/- and keep the balance for providing ancillary services which include nursing care, infrastructure facilities, paramedic care, emergency services, checking of temperature, weight, blood pressure etc. Will GST be applicable on such money retained by the hospitals? (2) Healthcare services have been defined to mean any service by way of diagnosis or treatment or care for illness, injury, deformity, abnormality or pregnancy in any recognized system of medicines in India[para 2(zg) of notification No. 12/2017-CT(Rate)]. Therefore, hospitals also provide healthcare services. The entire amount charged by them from the patients including the retention money and the fee/payments made to the doctors etc., is towards the healthcare services provided by the hospitals to the patients and is exempt (3) Food supplied to the patients: Health care services provided by the clinical establishments will include food supplied to the patients; but such food may be prepared by the canteens run by the hospitals or may be outso ..... X X X X Extracts X X X X X X X X Extracts X X X X ..... nical establishment or an authorized medical practitioner or para medics are exempted vide SI No 74 of Notification no 12/2017-C.T.(rate) dated 28.06.2017 as amended and SI No 74 of Notification No.II(2)/CTR/532(d-15)/2017 vide G.O. (Ms) No. 73 dated 29.06.2017 For ease of reference, the relevant entry is given below: SI. No. Chapter, Section, Heading, Croup or Service Code (Tariff) Description of Services Rate (per cent.) Condition (1) (2) (3) (4) (5) 74 Heading 9993 Services by way of- (a) health care services by a clinical establishment, an authorised medical practitioner or para-medics; (b) services provided by way of transportation of a patient in an ambulance, other than those specified in (a) above. Nil Nil "Clinical establishment" is defined in the said notification under 2(s), which states that,- "Clinical Establishment" means a hospital, nursing home, clinic, sanatorium or any other institution by, whatever name called, that offers services or facilities requiring diagnosis or treatment or care for illness, injury, deformity, abnormality or pregnancy in any recognized system of medicines in India or a place established as an independent entity or a ..... X X X X Extracts X X X X X X X X Extracts X X X X
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