TaxTMI 
TaxTMI 
2023 (6) TMI 487
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....". The issue raised by M/s Sanjeevani Psychiatric Clinic (hereinafter referred to as "applicant") un registered applicant. Applicant is registered as Partnership firm, under section 15 of The Clinical Establishment (Registration and Regulation) Act, 2010. The clinical Establishment is registered for providing medical services as a Single Specialty under Allopathy System of Medicine by Dr. Rinet Sonia Dsouza (MBBS, MD) is fit to pronounce advance ruling as it falls under the ambit of the Section 97(2) (b), (e) & (f)given as under: (b) applicability of a notification issued under the provisions of this Act; (e) determination of the liability to pay tax on any goods or services or both, (f) whether applicant is required to be registered; A. SUBMISSION OF THE APPLICANT: (in brief) 1. M/s Sanjeevani Psychiatric Clinic (hereinafter referred to as "applicant") registered as Partnership firm, is a clinical establishment located at Sardar Shahar Mega Highway, opp. Bhadu Petrol Pump, Rawatsar Distt. Hanumangarh-335524 under section 15 of The Clinical Establishment (Registration and Regulation) Act, 2010. The clinical Establishment is registered for providi....
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....On the basis of above, patients are examined by a psychiatrist who assesses the severity of illness, dependence of patient on drugs and his ability to withdraw from drugs. * On the basis of such examination, the psychiatrist prescribes medicines and the duration for which the medicines are required to be consumed. * The details of substance used by the patient and other parameters are also captured in Patient's file. iii. Dispensing of Medicine by psychiatrist - * Based on examination by the psychiatrist and prescription issued by him, patients are dispensed medicines in exact quantity as per the prescription of psychiatrist. * The patient has no choice to take the medicine from a general medical store or take medicine of a different brand or in a different quantity. * Moreover, the patient has no choice/freedom to take these Medicines from any other De-Addiction Center based on said prescription. * The drugs used for treating drug addicts are strictly government-controlled drugs and are not available for sale on general medical stores. * The name and quantity of the medicine dispensed to the patient along ....
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.... this clause, it is hereby clarified that, notwithstanding anything contained in any other law for the time being in force or any judgment, decree or order of any Court, tribunal or authority, the person and its members or constituents shall be deemed to be two separate persons and the supply of activities or transactions inter se shall be deemed to take place from one such person to another;] (b) import of services for a consideration whether or not in the course or furtherance of business; (c) the activities specified in Schedule I, made or agreed to be made without a consideration [(1A) Where certain activities or transactions constitute a supply in accordance with the provisions of sub-section (1), they shall be treated either as supply of goods or supply of services as referred to in Schedule II.] 5. That as per Section 2(30) composite supply is defined as (30) "composite supply" means a supply made by a taxable person to a recipient consisting of two or more taxable supplies of goods or services or both, or any combination thereof, which are naturally bundled and supplied in conjunction with each other in the ordinary course of business,....
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....ax which has been implemented in India, is governed by Section 9 of the CGST Act 2017 and SGST Act 2017 (hereinafter together known as "GST Act(s)) which lays its thrust upon supply of goods or services. The ingredients of a supply under the GST Act(s) have been enumerated under Section 7 of the Act(s) which has essentially four elements i.e. a) A Supply (Generic) b) Of Goods or Services c) For Consideration d) In course of or furtherance of business 11. That in the absence of any of these elements, the transaction falls beyond the scope of supply as given under the GST Act(s) and hence in such a case, the levy of tax would not be attracted. In the given scenario, on perusal of fact, it is evident that all the four elements as specified above are available to qualify the treatment of SUD Patients by the applicant as a supply. 12. That, in continuation of above, the subsequent issue for determination is whether this transaction is an individual supply of service or goods or both or whether it's a composite supply. A Composite Supply, from its definition under the Act(s) has following elements: a) a supply made by a taxable perso....
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.... the person with mental illness is likely to benefit from admission and treatment to the mental health establishment, (c) the person has understood the nature and purpose of admission to the mental health establishment, and has made the request for admission of his own free will without any duress or undue influence and has the capacity to make mental healthcare and treatment decisions without support or requires minimal support from others in making such decisions. 18. That thus as per the provisions of Mental Healthcare Act, a patient shall be admitted only on satisfaction of a medical officer or mental health professional that the seventy of illness requires admission or that the patient would benefit from admission or where the patient has made the request for admission of his own free will Thus, every patient who requires a treatment need not be admitted, patients can be treated as outpatients as well. 19. That further, as per Central Drugs Standard Control Organization (FDC Division), the medicines provided to SUD patients i.e. Buprenorphine 2 mg/0.4 mg sublingual Tablet and FDC of Buprenorphine (2 mg+0.5 mg and 0.4 mg + 0.1 mg) sublingual tablets are strictly ....
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....bed by the doctor. Further the medicine prescribed is required to be issued by the applicant to the patient on same day at the same time only. The said details are required to be maintained in Daily Dispensing Register. If medicine is not issued at the same time, then the doctor is again required to prescribe the same. Hence the prescription of medicine shall not absolve the applicant from its responsibility and the activity of treatment cannot be said to have been completed. 24. That on perusal of above it is evident that, unless the number of days specified in prescription for medicine consumption have passed, fresh prescription cannot be given by the doctor. Hence prescription, further issuance of medicine and prescription after re-examination of the patient are interdependent and cannot be bifurcated in any manner whatsoever. 25. That, based on above paras, it can be clearly said that the supply of medicine by the applicant to SUD patients as outpatient is a part of treatment and cannot be detached or taken up independently from the examination of the patient in addition to registration and counselling services. Thus, in our opinion, the given chronological activities of ....
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..... [Para 18] 30. That similarly in case of LevobVerzekeringen BV and OV Bank NV v Secretary of State for Finance, Netherlands* [2012] 22 taxmann.com 174 (ECJ) it was held Service - Definition of - Under a single contract, basic software supplied customization carried out and training provided by same supplier - prices were stipulated separately - Department contended that whole transaction amounted to 'supply of service' liable to service tax - HELD: All such elements were so closely linked that they constituted a single indivisible economic transaction. Separate pricing was not relevant. Predominant element was customization as only customization would make the software useful to consumer and price thereof was also higher. Since service element viz., customization was predominant, whole contract constituted a 'single supply of service' and was liable to service tax [In favor of revenue] Specified descriptions of services or Bundled Service - Principles of Interpretations -Combining various elements into single transaction - If two or more elements are so closely linked that they form a single indivisible economic supply, which can be sp....
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....gical procedures which require administering drugs and may involve installing stents, implants etc. as an essential part of such procedures, like open heart surgery, angiography, knee surgery, hip replacement etc. "A medical procedure commences with a patient visiting a hospital to elicit a doctor's opinion regarding his medical condition and in case he requires a medical procedure, information regarding the particulars of the procedure and the cost. The patient is, thereafter, informed of the particulars of the medical procedure, the drugs, implants, stents etc. that are required for his treatment/medical procedure and the cost. The patient accepts the offer and opts for a particular procedure. Once having opted for a particular procedure, the choice of the drugs, implants, stents etc. would depend upon medical advice and only were, medically permissible, the choice of the patient. The question posed before us would, therefore, must be further refined, namely, whether a medical procedure can be severed into separate elements of service and sale with service being the medical advice and medical procedure and the sale being the supply of medicines, surgical items, impla....
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.... * Any other system of medicine that may be recognized by central government 39. That on perusal of above it is evident that activity of treating SUD patients qualifies as Health Care service and thus is covered under its definition as given in para (zg) of notification no. 12 CGST Rate dated 28-06-2017. 40. That, the second condition that is required to be satisfied to fall under entry no. 74 of the said notification is that the Health Care services shall be provided by a clinical establishment as defined in para 2(s) of the Notification No. 12/2017-Central Tax (Rate), dated 28-6-2017. 41. That Clinical establishment as defined in the said notification shall mean 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 part of an establishment to carry out diagnostic or investigative services of diseases; 42. That there is no ambiguity in the fact that the applicant is a Clinical Establishmen....
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....GST Act and RGST Act are in pari materia and have the same provisions in like matter and differ from each other only on a few specific provisions. Therefore, unless a mention is particularly made to such dissimilar provisions, a reference to the CGST Act would also mean reference to the corresponding similar provisions in the RGST Act. 1) We have carefully examined the statement of facts, supporting documents filed by the Applicant along with application, oral and written submissions made at the time of hearing. We have also considered the issues involved, on which advance ruling is sought by the applicant, and relevant facts. We would like to discuss the submission made by applicant and will take up the above question for discussion one by one. 2) The applicant M/s Sanjeevani Psychiatric Clinic registered as Partnership firm. Applicant submitted provisional registration certificate issued by DRA & CMHO Hanumangarh regarding clinical establishment located at Sardar Shahar Mega Highway, opp. Bhadu Petrol Pump, Rawatsar Distt. Hanumangarh-335524 under section 15 of the Clinical establishment (Registration and Regulation) Act, 2010 The clinical establishment is registered for pr....
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....no. 12/2017-CGST Rate dated 28 06 2017? 5.2) So, we observe that there is no dispute that treatment of SUD Patients by the applicant is supply Sec. 7(1) of CGST Act, 2017 and falls under the ambit of GST. 5.3) The patients are being examined by applicant through its Single Specialty Psychiatrist under Allopathy System of Medicine by Dr Rmet Sonia Dsouza (MBBS, MD), who gives medicines to outdoor patients of applicant Thus, we observe that applicant is involved to treat out door patients only and medicines are being provided by applicant only as per requirement of patient Thus, applicant is involved in supply of service as well supply of goods i.e medicine. 6) Now we would like to examine next, whether the supply made by applicant is exempt under entry 74(a) of notification no 12/2017-CGST Rate dated 28 06 2017 and whether this is composite supply or not 6.1) The relevant portion of Notification no. 12/2017-CGST Rate dated 28-06-2017 as amended is as under-: SI.No. Chapter, Section, Heading, Group or Service Code (Tariff) Description of Services Rate (per cent.) Condition 74 Heading 9993 Services by way of- (a) health care services by a clinica....
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.... As per notification 2(k) "authorised medical practitioner" means a medical practitioner registered with any of the councils of the recognised system of medicines established or recognised by law in India and Includes a medical professional having the requisite qualification to practice in any recognised system of medicines in India as per any law for the time being in force; 2(s) "clinical establishment" means a hospital, nursing home, clinic, sanatorium oi any other institution by, whatever name called, that oilers services or facilities requiring diagnosis or treatment or care for illness, injury, deformity, abnormality or pregnancy in any recognised system of medicines in India, or a place established as .in independent entity or a part of an establishment to carry out diagnostic oi investigative services of diseases; 2(zg) "health care services" means any service by way of diagnosis or treatment or care for illness, injury, deformity, abnormality or pregnancy in any recognised system of medicines in India and includes services by way of transportation of the patient to and from a clinical establishment, but does not include hair transplant or cosmetic....