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2022 (7) TMI 403 - AAR - GSTClassification of supply - Composite Supply of heath care services or not - supply of medicines and consumables used In the course of providing health care services to out-patients by pharmacy unit of the Be well hospitals for diagnosis or treatment - exemption under N/N. 12/2017 CT (rate) read with Section 8(a) of GST - HELD THAT - Inpatient services means services provided by hospitals to inpatients under the direction of medical doctors aimed at curing, restoring and/or maintaining the health of a patient and the service comprises of medical, pharmaceutical and paramedical services, rehabilitation services, nursing services and laboratory and technical services till the patient gets discharged. A complete gamut of activities required for well-being of a patient from admission till discharge, provided by a hospital under the direction of medical doctors is a composite supply of service and is covered under 'Inpatient services' classifiable under SAC 999311. In the case at hand, the applicant being a chain of hospitals undertakes services of diagnosis, treatment which comprises of providing bed/ICU/room, nursing care, diagnostics including lab investigations and treatment surgical or otherwise under the directions of the Doctors. The hospital provides medicines and consumables to the In-patients in the course of treatment on the directions of medical doctor for which the In-patient is billed together by the hospital. The hospital cannot provide health services including diagnostic, treatment surgery etc. without the help of medicines to be taken during treatment and consumables used during their stay in the hospital. Only on using these medicines and consumable as required and prescribed by the doctors and administered during their stay will the treatment be complete - the supply of medicines and consumables are naturally bundled with the supply of health services. In this case, supply of health services is the principal supply as that is the reason the in-patients get admitted to hospital instead of buying the medicines or consumables and using on themselves. Therefore, supply of medicines and consumables to in patients in the course of their treatment till the patient is discharged is a composite supply of health services. However once the patient is discharged, the composite supply comes to an end and the review of the patient subsequent to discharge cannot be considered as part of the composite supply. Inpatient services means services provided by hospitals to inpatients under the direction of medical doctors aimed at curing, restoring and/or maintaining the health of a patient and the service comprises of medical, pharmaceutical and paramedical services, rehabilitation services, nursing services and laboratory and technical services till the patient gets discharged. A complete gamut of activities required for well-being of a patient from admission till discharge, provided by a hospital under the direction of medical doctors is a composite supply of service and is covered under 'Inpatient services' classifiable under SAC 999311. A joint reading of the 'Explanation of service' pertaining to 'Inpatient services' and the exemption above, it is evident that the exemption is applicable to a Clinical Establishment , when services by way of diagnosis or treatment or care for illness, etc. are undertaken by such establishment under the directions of a medical doctor. The applicant hospital is a Clinical Establishment and for the health care services provided as defined in the Notification above provided to inpatients from admission till discharge including the supply of medicines, implants and consumables, they are exempt under S1 No 74 of Notification no 12/2017-C.T. (rate) dated 28.06.2017 as amended and Si No 74 of Notification No.II (2)/CTR/532(d-15)/2017 vide G.O. (Ms) No. 73 dated 29.06.2017. Whether the supply of medicines and consumables used In the course of providing health care services to out-patients by pharmacy unit of the Be well hospitals for diagnosis or treatment would be considered as Composite Supply of heath care services under GST and consequently avail exemption under Notification 12/2017 CT(rate) read with Section 8 (a) of GST? - HELD THAT - In the case of in-patients, the hospital is expected to provide provide lodging, care, medicine and food as part of treatment under supervision till discharge from the hospital. But in the case of out-patients, there is no such expectation on the hospital and the out-patient just walks in for consultation and advise. Hence it is clear that the service of supply of medicines and consumables and consultation of out-patients is not inextricably linked and not naturally bundled. Therefore pharmacy run by hospital dispensing medicine to outpatient or bye standers or others can be treated as individual supply of medicine and not covered under the ambit of health care services. Hence such supply of medicines and allied goods are taxable. The Supply of medicines and consumables used in the course of providing health care services to In-patients by pharmacy unit of Be well hospitals for diagnosis or treatment during the patients admission in hospital till discharge is to be considered as Composite 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. However the supply of medicines and consumables used in the course of providing health care services to Out-patients by pharmacy unit of Be well hospitals for diagnosis or treatment during the patients admission in hospital cannot be considered as Composite Supply of health care service as under GST and are taxable as individual supplies as established.
Issues Involved:
1. Whether the supply of medicines and consumables to in-patients by the pharmacy unit of Be Well Hospitals constitutes a "Composite Supply" of health care services under GST and is consequently exempt under Notification No. 12/2017-CT (Rate) read with Section 8(a) of GST. 2. Whether the supply of medicines and consumables to out-patients by the pharmacy unit of Be Well Hospitals constitutes a "Composite Supply" of health care services under GST and is consequently exempt under Notification No. 12/2017-CT (Rate) read with Section 8(a) of GST. Detailed Analysis: Issue 1: Supply of Medicines and Consumables to In-Patients 1. Composite Supply Definition: Section 2(30) of CGST ACT defines "composite supply" as a supply consisting of two or more taxable supplies of goods or services which are naturally bundled and supplied in conjunction with each other in the ordinary course of business, one of which is a principal supply. 2. In-Patient Services: The hospital provides comprehensive treatment to in-patients, including room rent, nursing care, diagnostics, medicines, and consumables. These services are billed together, indicating a composite supply where the principal supply is health care services. 3. Circular No. 32/06/2018-GST: This circular clarifies that the entire amount charged by hospitals from patients, including retention money and payments to doctors, is towards healthcare services and is exempt. 4. Explanation to Classification of Services: SAC 999311 includes inpatient services that comprise medical, pharmaceutical, paramedical services, nursing services, and laboratory services provided under the direction of medical doctors. 5. Ruling: The supply of medicines and consumables to in-patients during their stay in the hospital is considered a composite supply of health care services. This supply is exempt under Si No 74 of Notification No. 12/2017-CT (Rate) dated 28.06.2017 and Notification No.II(2)/CTR/532(d-15)/2017. Issue 2: Supply of Medicines and Consumables to Out-Patients 1. Nature of Out-Patient Services: Out-patients visit the hospital for consultation and may receive prescriptions for medicines and consumables. However, they are not mandated to purchase these from the hospital pharmacy and can buy them from any pharmacy of their choice. 2. Billing Practices: Separate bills are issued for consultation and pharmacy supplies, indicating that these services are not naturally bundled. 3. Circular No. 32/06/2018-GST: This circular clarifies that supplies of food to out-patients or their attendants are taxable, implying that similar principles apply to the supply of medicines and consumables. 4. Ruling: The supply of medicines and consumables to out-patients is not considered a composite supply of health care services. These supplies are taxable as individual supplies under GST. Conclusion: 1. In-Patients: The supply of medicines and consumables to in-patients during their hospital stay is a composite supply of health care services and is exempt from GST. 2. Out-Patients: The supply of medicines and consumables to out-patients is not a composite supply of health care services and is taxable under GST. Ruling: 1. In-Patients: Supply of medicines and consumables used in the course of providing health care services to in-patients admitted to the hospital for diagnosis, medical treatment, or procedures till discharge is a composite supply of In-Patient Healthcare Service and is exempt from CGST and SGST. 2. Out-Patients: Supply of medicines and consumables used in the course of providing health care services to out-patients is not a composite supply and is taxable to GST.
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