TaxTMI 
TaxTMI 
2026 (2) TMI 458
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....2017 for above charges recovered from in patients under 1 common contract/invoice? 1 At the outset, we would like to make it clear that the provisions of both the CGST Act and the MGST Act are the same except for certain provisions. Therefore, unless a mention is specifically made to any dissimilar provisions, a reference to the CGST Act would also mean a reference to the same provision under the MGST Act. Further to the earlier, henceforth for the purposes of this Advance Ruling, the expression 'GST Act' would mean CGST Act and MGST Act. 1. FACTS AND CONTENTION - AS PER THE APPLICANT 1.1 The applicant is a partnership firm and operating as nursing home. The renewed registration certificate under Maharashtra Nursing Home Registration Act, 1949. 1.2 The applicant provides health care services with the help of professional doctors and is equipped to treat the patients admitted to the hospital. Also, the hospital has its in-house pharmacy/ chemist operating under trade name "LAXMI CHEMIST" for supply of medicines and allied items. For the purpose of administration and identification, the patients visiting the hospital are categorized as "in-patients" and "out-patients". ....
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.... and other tests as required • Carry out X-ray/ Scanning, etc as required 2.2 The in-patient is under continuous monitoring of the doctors and nursing staff and administration and dosage of medication is all under the control of the doctor and the nursing staff. The entire treatment protocol is documented and recorded. The invoice/bill raised for the treatment as an inpatient is a single bill Charging for all the facilities/ services utilized for the treatment in the hospital including room rent, nursing care charges, laboratory, consumables, medicines, equipment charges, doctor's fee, etc. 2.3 In other words, the patient admitted to the nursing home is concerned with getting treatment and cure for his disease. The applicant in the course of rendering treatment to such patients provides one or more of the above services as required. Thus, it is submitted that they are providing single supply of health care services which comprised of several aspects i.e. services and goods. The entire services are provided in ordinary course of their business to treat the in-patients. 2.4 The term "composite supply" as provided u/s 2(30) of CGST Act, 2017. (30) "compo....
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....arge from the hospital. Supplies of these services are part and parcel of the treatment and they are essentially required to provide health care services. Inpatients receive medical facility as per the scheduled procedure and have strict restriction to ensure quantity/quality of items for consumption. 2.10 As regards composite supply, there has to be presence of 2 or more taxable supply of goods or services. In instant case in our view there is only one and single healthcare supply services and absence of second supply, the transaction cannot be covered under composite supply. 2.11 Reference is be made to Circular No. 32/06/2018-GST dated 12th February,2018 issued pursuant GST council 25th meeting which clarifies that: * Hospitals provide healthcare services. The entire amount charged by them from the patients including the retention money and the fee/payments made to the doctors etc., is towards the healthcare services provided by the hospitals to the patients and is exempt. Food supplied to the in-patients as advised by the doctor/nutritionists is a part of composite supply of healthcare and not separately taxable. Other supplies of food by a hosp....
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....ng any surgery or treatment related to curing or enhancing aesthetic appearance of their customers by performing cosmetic/plastic surgeries. 2.16 Reference is made to Circular No. 27/01/2018-GST dated 4th January,2018 issued clarifies that rent on rooms charged by hospitals to in-patients is exempt (Refer Sr. No. 4 of said circular). 2.17 We also place reliance on following rulings given by various authority of advance ruling wherein it is held that supply of medicines, surgical items etc. provided during the course of treatment to in-patients admitted to hospital is incidental to principal supply of health care services and therefore exempt under entry 74 of notification 12/2017-CTR: • M/s Baby Memorial Hospital Ltd [(2019) 11 TMI 154 -KERALA AAR] • M/s Terna Public Charitable Trust [(2019) 7 TMI 1331 - MAHARASHTRA MAAR] • M/s CMC Vellore Association [(2020) 7 TMI 380 - ANDHRA PRADESH AAR] • M/s Ernakulam Medical Centre Pvt Ltd [(2019) 3 TMI 757 - KERALA AAAR] 2.18 In view of above facts, the services provided by the applicant fall within the ambit of exemption entry 74 & definitions related to it as provided in above no....
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....LTHCARE SERVICES. 2.25 Appellant are providing range of services under the supervision of doctors, which inter alia includes: • Visit and treatment by the professional doctors • Stay facility / bed charges • Provision of medicines/consumable • Care by the nurses • Carry out pathological tests and other tests as required • Carry out X-ray/ Scanning, etc. as required 2.26 The Patients admitted to nursing home for seeking medical treatment for their illness. The applicant provides necessary services and goods (i.e. medicines, consumables etc.) as part of this treatment. Hence, it is a single supply of healthcare services offered in the ordinary course of treating in-patients. 2.27 CBIC vide Circular No. 32/06/2018-GST dated 12th February,2018 clarified that Hospital providing Health care services, total amount charges from patients, including retention money and payments to doctors, is for healthcare services and is exempt from GST. 2.28 In view of above we are of the view that our services provided to In-Patients is SINGLE SUPPLY. APPLICANT FALLS WITHIN THE DEFINITION OF "CLINICAL ESTABLISHME....
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....e ICCU (The applicant / Hospital) is a nursing home The renewed partnership firm and operating as Registration Certificate under Maharashtra Nursing Home Registration Act-1949. 3.2 The applicant provides Health care services with the help of professional doctors and is equipped to treat the patients admitted to the hospital. Also, the hospital has its in-house pharmacy / chemists operating under the Trade Name LAXMI CHEMIST FOR supply of Medicines and allied Items. 3.3 The "in-Patients" are those who are advised and admitted the Hospital for getting the required treatment. These patients are under continuous monitoring of doctors & Nursing Staff. They are provided with stay facility medicines, consumables etc. during the treatment. The entire treatment protocol is documented and recorded the medicines are prescribed to them as part of treatment and care for illness. The invoice/bill raised for the treatment to an impatient is single bill with detailed bifurcation of charges (like room rent, nursing care charges, laboratory, consumables medicines, equipment charges, A doctor's fee etc.) towards all the facilities/services/services provided during treatment in the Hospital. ....
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.... documented and recorded. The medicines are prescribed to them as part of treatment and care for illness. The invoice/bill raised for the treatment to an inpatient is a single bill with detailed bifurcation of charges (like room rent, nursing care charges, laboratory, consumables, medicines, equipment charges, doctor's fee, etc.) towards all the facilities/ services provided during the course of treatment in the hospital. The sample copies of invoices/ case paper/ discharge summary for treatment of in-patients are attached with the application. 5.4 The "out-patients" or commonly referred as walk-in customers and are those who visit the hospital for consultation, diagnosis and check-up from the professional doctors. The doctors based on their diagnosis prescribe medicines to such patients. Thereafter, it is the choice of the patient whether to follow the medical advice given by the doctor or not. These patients are not admitted to hospital for treatment. These patients at their choice may purchase the medicines prescribed from the pharmacy shop run by the hospital on making payment of charges. 5.5 In the instant case, the healthcare services rendered to in-patients is first ta....
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....ical Care Unit (CCU)/Intensive Cardiac Care Unit (ICCU)/Neo natal Intensive Care Unit (NICU)] having room charges exceeding Rs. 5000 per day to a person receiving health care services.". (b) services provided by way of transportation of a patient in an ambulance, other than those specified in (a) above. 5.8 "Clinical Establishment" is defined in the said notification under: 2(s), as "Clinical Establishment" means 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". 5.9 "Health care services" is defined under para 2(zg) as follows:- "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 cl....
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....f services & goods which are offered to the inpatients in a hospital are naturally bundled supplies and liable to be taxed at the rate of provided for 'health care services' as it is the principal supply. Sl. No. 74 of Notification No. 12/2017-CT(R) provides for exemption to healthcare services. This entry is further amended by Notification No. 4/2022 CT(R) dated 13.07.2022 to provide that nothing in this entry shall apply to the services provided by a clinical establishment by way of providing room (excluding ICU/CCU, etc.) having room charges exceeding Rs. 5000/- per day to a person receiving healthcare services. Thus, we find that the exemption under S.No.74 of Notification No. 12/2017-CT (R) is not a blanket exemption. It is qualified by a proviso which says that the benefit of the said notification would not be applicable to the services provided by a clinical establishment by way of room (excluding ICCU/CCU etc) having room charges exceeding Rs. 5000/- per day to a person receiving healthcare services. Therefore, even though the services provided by the applicant is a composite service of healthcare, food, room charges, medicines etc., and the principle supply in such c....
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....ite supply" of health care service under GST and consequently exemption under Notification No. 12/2017-CT (Rate) read with Section 8(a) of GST is available for such supplies based on the discussions above, while supply of mobility-aids, prosthetics, etc which are independent supplies are not part of 'Composite supply' of 'Health Care services'. 5.16 In the case of M/s. Kinder Womens Hospital and Fertility Centre private Limited, the applicant had sought Advance Ruling from Kerala AAR on the following questions: - Q) Whether the supply of medicines, consumables, surgical items, items such as needles, reagents etc used in laboratory, room rent used in the course of providing health care services to in patients for diagnosis or treatments which are naturally bundled and are provided in conjunction with each other, would be considered as "Composite Supply" and eligible for exemption under the category 'health care services' under SI.No. 74 of Notification No. 12/2017-CT(R) dated 28th June, 2017. The Advance Ruling Authority of Kerala answered as, "The supply of medicines, consumables, surgical items, items such as needles, reagents etc used in laboratory, room ten used in the ....