Health facilities will not be allowed to sign contracts with the Social Health Authority (SHA) for services they are not licensed to provide, in a new requirement that will determine which services hospitals can offer under the 2026-2029 health insurance contracts.
Health Cabinet Secretary Aden Duale and the Health committee of the Council of Governors (CoG) agreed to this requirement as part of measures to strengthen regulatory compliance, the quality of care, and patient safety.
‘Facilities will only be contracted for services for which they are duly licensed. The National and County Governments reaffirmed their commitment to ensuring that eligible public health facilities complete the contracting process on time, continuing to provide quality, accessible, uninterrupted services to SHA beneficiaries,’ they said in a statement.
Under the new arrangement, a facility cannot use its SHA contract to offer or claim payment for a service unless it holds the relevant licence. Therefore, a hospital may be contracted for some services but not others if it does not meet the relevant licensing requirements.
The guidelines stipulate that laboratory services must be licensed by the Kenya Medical Laboratory Technicians and Technologists Board (KMLTTB), pharmacy services by the Pharmacy and Poisons Board (PPB), and imaging services by the Kenya Nuclear Regulatory Authority (KENRA).
Meanwhile, Level Four and Level Five facilities have three months to meet the compulsory laboratory licensing requirements.
This licensing requirement comes as the SHA and the CoG implement the 2026-2029 contracting cycle. The current facility contracts have been extended to October 14, 2026, and will not be extended further.
‘The Cabinet Secretary for Health, Aden Duale, and the Health Committee of the Council of Governors (CoG) have agreed that the current Social Health Authority (SHA) facility contracts, which were extended to 14 October 2026, will not be extended any further,’ the statement read.
The SHA said that it will establish HAKIKA, a digital platform that will be used to manage the contracting of healthcare providers, and will contract clinics in every county by October 14 to help eligible facilities complete the contracting process.
Facilities that have met all other contracting requirements will have 30 days to submit any outstanding documentation from the National Social Security Fund (NSSF), the National Environment Management Authority (NEMA), the fire safety authorities, the National Council for Persons with Disabilities (NCPWD), and the Office of the Data Protection Commissioner (ODPC).
‘The conditional compliance period does not exempt facilities from their statutory obligations,’ read the statement.
The stakeholders also agreed on a 90-day timeline for the payment of clean claims. The SHA is required to pay these within 90 days of receipt, in the order in which they were received.
If available funds are insufficient to settle a clean claim within the 90 days, the unpaid amount will be recognised as a certified liability and carried forward for settlement within the same financial year, subject to the provision of appropriate funds.