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Issues: (i) Whether medicines, consumables, room rent up to the prescribed limit, nursing care and other ancillary supplies provided to inpatients form a composite supply of healthcare services eligible for exemption; (ii) Whether medicines or other goods supplied to outpatients fall within the healthcare exemption; (iii) Whether room rent exceeding Rs. 5,000 per day per patient is exempt.
Issue (i): Whether medicines, consumables, room rent up to the prescribed limit, nursing care and other ancillary supplies provided to inpatients form a composite supply of healthcare services eligible for exemption.
Analysis: Healthcare services under the exemption notification cover diagnosis, treatment and care by a clinical establishment. Where medicines, consumables, dietary food, room accommodation and allied services are supplied to inpatients in the course of continuous treatment, these supplies are naturally bundled and supplied in conjunction with healthcare in the ordinary course of business. Such a bundle answers the definition of composite supply, with healthcare service as the principal supply. The circular relied upon also supports the view that inpatient supplies integrally connected with treatment are not separately taxable.
Conclusion: The inpatient bundle is a composite supply with healthcare service as the principal supply and is exempt, except to the extent specifically carved out for room rent above the notified threshold.
Issue (ii): Whether medicines or other goods supplied to outpatients fall within the healthcare exemption.
Analysis: Outpatient medicines are not supplied as part of a naturally bundled, continuous course of treatment under the control and supervision of the hospital. The patient is free to procure medicines from any source, and the supply is not inseparably linked with a composite healthcare service. Such supplies therefore do not satisfy the test of composite supply for exemption.
Conclusion: Medicines or other goods supplied to outpatients are not covered by the healthcare exemption and are taxable at the applicable GST rate.
Issue (iii): Whether room rent exceeding Rs. 5,000 per day per patient is exempt.
Analysis: The amending notification expressly withdraws the exemption for room charges above Rs. 5,000 per day per patient, other than specified intensive care rooms. This carve-out applies even where the broader treatment remains exempt as healthcare service.
Conclusion: Room rent exceeding Rs. 5,000 per day per patient is taxable and not exempt.
Final Conclusion: The ruling grants exemption for inpatient healthcare services as a composite supply, but denies exemption for outpatient supplies and for room rent above the prescribed limit.
Ratio Decidendi: Supplies that are naturally bundled and inseparable from inpatient healthcare treatment constitute a composite supply with healthcare as the principal supply and are exempt, whereas outpatient goods and room charges above the notified threshold are independent taxable supplies.
Healthcare exemption for inpatient composite supply, while outpatient medicines and excess room rent remain taxable under GST.
Inpatient medicines, consumables, room rent within the notified limit, nursing care and allied supplies are treated as a naturally bundled composite supply, with healthcare service as the principal supply, and are exempt. Medicines or other goods supplied to outpatients are not part of a continuous, supervised treatment bundle and therefore do not qualify for the healthcare exemption; they are taxable at the applicable GST rate. Room rent exceeding Rs. 5,000 per day per patient is expressly carved out from exemption and remains taxable, except for specified intensive care rooms.
Eligibility of composite supply of healthcare services - medicines, consumables, room rent up to the prescribed limit, nursing care and other ancillary supplies provided to inpatients - Benefit of exemption under Sl. No. 74 of Notification No. 12/2017-Central Tax (Rate) - Inpatient and outpatient distinction - Taxability of room rent exceeding Rs. 5,000 per day per patient. Whether the healthcare services provided by the applicant, including the supply of medicines and other ancillary services in the course of treatment, qualify for exemption under Sl. No. 74 of Notification No. 12/2017-Central Tax (Rate) dated 28.06.2017. - HELD THAT: - The Authority held that, in the case of inpatients, medicines, consumables, room accommodation and other ancillary elements are supplied in conjunction with medical treatment under the supervision of the clinical establishment and are not ordinarily supplied independently. Such elements are therefore naturally bundled with the principal supply of healthcare service and assume the character of a composite supply. Since the principal supply is healthcare service rendered by a clinical establishment in a recognised system of medicine, the bundled inpatient supply falls within Entry No. 74 of Notification No. 12/2017-Central Tax (Rate) and is exempt, subject to the specific statutory exclusion relating to room rent. [Paras 7] Inpatient supplies forming part of the course of treatment were held to be an exempt composite supply of healthcare service under Entry No. 74. Inpatient and outpatient distinction - Independent taxable supply - Taxability of hospital room rent - Medicines or other goods supplied to outpatients do not qualify for exemption as healthcare services, and room rent beyond the notified threshold is separately taxable. - HELD THAT: - The Authority held that outpatient transactions do not possess the attributes of a naturally bundled supply because the patient is not admitted for a continuous course of treatment under the hospital's control and remains free to procure prescribed medicines from any source. Medicines or allied goods supplied in such circumstances therefore do not form part of an exempt healthcare composite supply and are taxable at the applicable rates. The Authority further held that, by virtue of the amendment made through Notification No. 04/2022-Central Tax (Rate), the exemption under Entry No. 74 does not extend to room rent, other than ICU, CCU, ICCU and NICU rooms, where the room charges exceed Rs. 5,000 per day per patient, and such room rent is chargeable to GST as specified. [Paras 7] Outpatient supply of medicines or goods was held taxable as an independent supply, and non-ICU room rent exceeding the prescribed threshold was held outside the exemption. Final Conclusion: The Authority ruled that healthcare services provided by the applicant to inpatients, together with medicines, consumables and other naturally bundled ancillary services, are exempt under Entry No. 74 as a composite supply of healthcare service. Supplies of medicines or other goods to outpatients are taxable, and the exemption does not cover non-ICU room rent exceeding the prescribed threshold.