RUPHA announces operational guidelines for private hospitals ahead of SHA services suspension

In a communiqué on Sunday, RUPHA noted that the guidelines are to ensure patients are not abandoned while protecting healthcare providers from financial collapse.

Member facilities were therefore ordered to continue providing emergency care to stabilize patients and once stabilized, patients who opt to exclusively use their SHA or MAKL medical covers shall be referred to a hospital of their choice.

"Emergency cases shall not be denied care under any circumstances," read the statement in part.

RUPHA further ordered that patients admitted under SHA or MAKL before February 24, 2025, shall continue receiving care under the existing terms until discharge. 

Scheduled outpatient appointments made before the aforementioned date shall also be honored.

Hospitals have also been urged to inform patients of the suspension through a professional and procedural approach with a caveat of not issuing public notices or social media posts.

Patients who will not be able to receive medical attention after the suspension will also be provided with alternative options among them cash payments for those who can afford to continue receiving care, referral to any hospitals that may continue accepting MAKL/SHA coverage or an alternative private insurance scheme for those with additional medical cover.

In-patient admissions post-suspension have also been prohibited "unless SHA or MAKL provide an upfront payment guarantee" unless the patient has an alternative payment option.

All facilities will however continue submitting claims for services rendered before the suspension date, ensuring they follow proper documentation to facilitate payment pursuit.

RUPHA has maintained that it remains open to engagement if the government commits to resolving their demands which they claim have been ignored by the government, endangering the lives of patients. 

"Until then, hospitals must prioritize financial sustainability and patient safety," RUPHA stated.

It demands the payment of Ksh.30 billion debt in NHIF arrears which they say they are willing to accept a payment plan for not more than a period of 3 months.

Since its introduction in October 2024, the new healthcare scheme has been rocked with endless glitches as Kenyans complain of its inefficiency.