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Circular 58 of 2021: Administrators and Managed Care Organisations Accredited by the CMS Council

The Council for Medical Schemes (CMS) hereby confirms that the Executive Committee (EXCO) of Council considered and resolved to approve the renewal of accreditation/compliance certificate of the organisations/ medical schemes listed below, at its meetings held on 13 August and 13 October 2021 respectively.

 

Managed Care Organisation – New Application

Oncology Healthcare Management Company (Pty) Ltd: Renewal of accreditation was granted for a period of two years from 13 October 2021 for the following services, with conditions as stipulated on the CMS website:

a. Managed Care Network Management Services and Risk Management

  • Specialist network – Oncology

 

Managed Care Organisations – Renewal Applications

2. Centre for Diabetes and Endocrinology (Pty) Ltd: Renewal of accreditation was granted for a period of two years from 31 October 2021 for the following services, with conditions as stipulated on the CMS website:

a. Active Disease Risk Management Services

  • Cardiac Failure/ Cardiomyopathy/ Dysrhythmias/ Coronary Artery Disease
  • Diabetes Mellitus (Type 1 and 2)
  • Hyperlipidaemia
  • Hypertension
  • Mental Health Services
  • Chronic Renal Disease

 

Managed Care – Self-administered medical schemes: Compliance Certificate Renewal Applications

3. Chartered Accountants Medical Aid Fund (CAMAF) (Self-administered): Renewal of the compliance certificate was granted for a period of three years from 13 November 2021, for the following services with no conditions.

a. Hospital Benefit Management

  • Pre-authorisation
  • Case Management
  • Clinical Audit

b. Pharmacy Benefit Management

  • Pre-authorisation
  • Drug utilisation review (DUR)

c. Active Disease Risk Management Services.

  • Asthma /COPD/Bronchiectasis
  • Cardiac Failure / Cardiomyopathy /Dysrhythmias/Coronary Artery Disease
  • Diabetes (Type 1 and 2)
  • Hyperlipidaemia
  • Hypertension
  • Depression / Bipolar
  • Oncology
  • HIV
  • Muscular Skeletal Programme

d. Managed Care Network Management Services and Risk Management

  • General Practitioner
  • Specialist Network
  • Hospital Network
  • Pharmacy Network
  • Dental Network
  • Auxiliary Network

 

4. Medihelp Medical Scheme (Self-administered): Renewal of the compliance certificate was granted for a period of three years from 13 November 2021 for the following services with no conditions.

a. Hospital Benefit Management

  • Pre-authorisation
  • Case Management

c. Pharmacy Benefit Management

  • Pre-authorisation
  • Drug utilisation review (DUR)

d. Managed Care Network Management Services and Risk Management

  • GP network
  • Pharmacy network
  • Specialist network (Orthopaedic surgeons, General surgeons, Physicians)
  • Pathology network

 

Administrators – Self-administered medical schemes: Compliance Certificate Renewal Applications

  1. Chartered Accountants Medical Aid Fund (CAMAF) (Self-administered): Renewal of the compliance certificate was granted for a period of three years from 23 October 2021, with no conditions.
  2. Medihelp Medical Scheme (Self-administered): Renewal of the compliance certificate was granted for a period of three years from 13 November 2021, with no conditions.
  3. Genesis Medical Scheme (Self-administered): Renewal of the compliance certificate was granted for a period of three years from, 13 August 2021 with no conditions.

The above-mentioned Managed Care and Administrators conditions and status can be viewed here.

 

Download the Circular here.

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