LAGOS STATE HEALTH SCHEME LAW

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LIST OF LAWS OF LAGOS, [ALPHABETICAL]  

CHAPTER L32, LAWS OF LAGOS STATE, NIGERIA, 2015

LAGOS STATE HEALTH SCHEME LAW

ARRANGEMENT OF SECTIONS 

1.       Interpretation

2.       Establishment of the Lagos State Health Management Agency                                             

3.       Objects of the Agency

4.       Establishment and Composition of the Lagos State Health Management Agency Governing Board

5.       Establishment of the Lagos State Health Management Agency Governing Board

6.       Components of the Lagos State Health Scheme

7.       Powers of the Board

8.       Functions of the Board

9.       Tenure of Office of Members of the Board

10.     Remuneration and Allowances

11.     Cessation of Membership of the Agency

12.     Vacancy

13.     Proceedings

14.     Quorum

15.     Meetings

16.     Committee of the Board

17.     Power to Co-opt

18.     Validity of Proceedings

19.     Seal of the Agency

20.     Objectives of the Health Scheme

21.     Applicability of NHIS Act to the Law

 22.    Prohibiting Health Care Organisation from Refusing Coverage based on Patient’s Medical History

23.     General Manager and other Staff of the Agency

24.     Legal Adviser

25.     Pensions

26.     Appointment of Consultants for the Agency

27.     Creation and Management of Lagos State Health Fund

28.     Disbursement of the Fund

29.     Power to accept Gift

30.     Annual Estimate Account

31.     Audit

32.     Annual Estimate Account

33.     Exemption from Tax

34.     Payment of Contribution under the Scheme

35.     Registration of Lagos State Residents Employers and Employees

36.     Registration and Services of Health Care Provider

37.     Registration of Maintenance Organisations, Mutual Health Association and Allied Associations

38.     Refusal of Licence

39.     Revocation of Licence

40.     Functions of HMOs and MHAs

41.     Registration of Medical Practitioners with the Scheme

42.     Medical Document to be Duly Signed

43.     Participation of Local Governments Appointment of Focal Persons

44.     Functions of the Lagos State Health Management Agency Arbitration Panel

45.     Prosecution of Offender

46.     Jurisdiction

47.     Payment of Contribution

48.     Commencement of Proceedings

49.     Limitation of Suits Against the Agency, etc.

50.     Services of Document

51.     Restriction on Execution against Property of the Agency

53.     Confidentiality and Non-Disclosure

54.     Contributions to be Inalienable

55.     Transfer of Liability of Contribution in the case of Mergers/Acquisitions, etc.

56.     Exclusion from application of Cap 449 LFN

57.     Collaboration with the Federal Government

58.     Professional Indemnity for Health Care Providers

59.     Power to make Regulations

60.     Power to Audit Enter and Inspect

61.     Withholding Payments

62.     Offences and Penalties

63.     Offences by Bodies Corporate, etc.

64.     Citations and Commencement    

LAGOS STATE HEALTH SCHEME LAW

A LAW TO PROVIDE FOR THE ESTABLISHMENT OF THE LAGOS STATE HEALTH MANAGEMENT AGENCY AND THE LAGOS STATE HEALTH SCHEME FOR RESIDENTS OF LAGOS STATE AND FOR CONNECTED PURPOSES

THE LAGOS STATE HOUSE OF ASSEMBLY enacts as follows:-

1.      Interpretation

In this Law. unless the context otherwise requires—

“Actuary” means a statistician who calculates risks and probabilities for payment plan;

“Administrative Charges” means 10 per cent of the funds from the Lagos State Health Plan, Private Health Plans and the Formal Sector Plan;

“Agency” means the Lagos State Health Management Agency established under section 2 of this Law:

“Benefit” means a benefit or advantage of any kind derived from the Scheme;

“Capitation” means a payment to a health care provider in respect of covered services to be provided to an insured person registered with the health care provider, whether the person uses the services or not:

“Commissioner” means the Commissioner charged with responsibility for matters relating to health in the State;

“Contribution” means a premium payable to HMOs, MHAs, Lagos State Health Fund LASHEF) and any other fund under this Law;

“Employee” means a person who resides in Lagos State and is employed in the public or pd-ate sector or an apprenticeship with an employer whether the contract is express or implied, oral or in writing;

“Employer” means an employer with five (5) or more employees which includes the Federal, State and Local Government or any Extra-Ministerial Department or a person with whom an employee has entered into a contract of service or apprenticeship and who is responsible for the payment of the wages or salaries of the employee including the lawful representative, successor or assignee of that person;

“Health Care Practitioner” means any health care personnel such as doctors, nurses, laboratory scientists, pharmacists, physiotherapists, radiographers and as defined by the Agency;

“Health Care Provider (HCP)” means any government or private health care facility, hospital, maternity centre. community’ pharmacies and all other service providers registered by the Agency for the provision of prescribed health services for insured persons and their dependants under this Scheme:

“HEFAMAA” means Health Facility Monitoring and Accreditation Agency saddled with the responsibility of accrediting Health care facilities and other relevant Institution;

“HMO” means a Health Maintenance Organisation registered under section 37 of this Law to ensure health care services are adequately provided by health care providers approved by the Agency;

“ lnsured Person” means a person who is duly registered and pays the required contribution under this Scheme and his eligible dependant;

“Lagos State Health Fund (LASHEF)” means the sole, risk-pooling account into which all funds for health insurance in the State shall be paid and managed by the Lagos State Health Management Agency;

“Local Government Area” includes Local Council Development Area;

“Medical Documents” includes all prescriptions, laboratory forms. excuse duty, death certificate and other documents used in the management of patients under the Scheme covered by this Law;

“Medical Practitioner” means a person with a medical related degree registerable with the Medical and Dental Council of Nigeria;

“Member of the Board” means any person, including the Chairman who serves on the Board;

“MHA” means a Mutual Health Association registered under section 37 of this Law to provide health care services through health care providers approved by the Agency;

“NHIS” means National Health Insurance Scheme as defined in the National Health Insurance Scheme Act of 1999 of the Federal Republic of Nigeria Laws N42 VOL II 2004;

“Provider Payment Mechanism” means payment made directly to HMOs, MHAs and other providers for complete health care services, following approved referrals and/or professional services (specialist consultation, pharmaceutical care services, laboratory and radiological investigations etc.) under this Scheme;

“Resident” is as defined by Lagos State Residents Registration Agency (LASRRA) Law;

“State” means Lagos State of Nigeria;

“Vulnerable” refer to the following categories of people, pregnant women, children under five (5) years, the aged (as defined by the Agency), the disabled, the poor and others falling within the group;

“wage” means remuneration in money paid to an employee under his contract of service or apprenticeship whether agreed to be paid at fixed or determined intervals of time.

LAWS OF LAGOS STATE

LAWS OF THE FEDERAL REPUBLIC OF NIGERIA