Empanelment of AYUSH Hospitals Centers under CGHS

Empanelment of AYUSH Hospitals / Centers under CGHS

F. No Z. 28015/01/2006-HD Cell/CGHS/
Government of India
Ministry of Health & family welfare
Directorate General of Central Government Health Scheme

Nirman Bhavan, New Delhi
Dated: 01.10.2015

OFFICE MEMORANDUM

Subject: Empanelment of AYUSH Hospitals / Centers under CGHS and CS (MA) Rules for Ayurveda. Unani and Yoga & Naturopathy treatments/ procedures and Fixation of Package rates.

Reference is invited to the Notification. No Z. 28015/01/2006-HD Cell/ AYUSH/ CGHS/HQ/Pt-I, dated 03/7/2015 and O.M. No. Z. 28015/01/2006-HD Cell/CGHS dated 3/7/2015.

The undersigned is directed to state that after following the prescribed proceedure and on submission of required documents like Memorandum of Aggreement, Performance Bank Gaurantee and Acceptance letter etc. by the QCI recommended AYUSH Hospitals and Centers for empanelment under CGHS and CS (MA) Rules were considered by the competant aurhority and approved. The list of such AYUSH hospitals and package rates/rates for treatments/ procedures are enclosed as Annexures “A” and “B” respectively. The rates and the O.M. is valid for a period of 6 months from 3/7/2015 to 02/1/2016 or new rates are finilised through fresh tender process whichever is earlier.

2. The undersigned is further directed to clarify as under

(a) “Package Rate” means rates for a package of treatment of standard set of procedures that are administered to the patient while undergoing treatment for a pre-diagnosed disease condition for the specified time period. The package rates which are specified for diagnosed diseases/conditions in Annexure “B” should strictly be adhered. Procedures other than the package rates listed in Annexure “B” for a nonspecific disease condition which is not mentioned under package rates will be considered as per the list. The duration of the treatments should not exceed 34 days for Ayurveda and 28 days for Yoga and Naturopathy in the light of P.M. dated 1-1-2008.

i) This includes all charges pertaining to a particular treatment/procedure including registration charges, admission charges, accommodation charges, cost of medicines, Panch Karma charges, Labor Room charges, charges for Kshar sutra operation/procedure charges Doctor/Consultant visit charges, Monitoring charges, operation theatre charges, procedural charges/Surgeon’s fee , cost of disposable surgical charges and cost of all sundries used during hospitalization related to routine investigations, physiotherapy charges etc. from the time of admission to till discharge. This also is inclusive of all sub-procedures and related procedures to complete the treatment.

ii) No additional charge on account of extended period shall be allowed if that extension is due to any improperly conducted procedure.

(b) The rates not indicated in Annexure “B” in respect of items under the head of admission fee, consultation fee, laboratory Investigations/diagnostic tests/procedures, hospitalization Nursing care, Transportation, engagement of attendants etc. will be the same as prescribed for recognized private Allopathic Hospitals under the CGHS. The rates pertain to 2008 of allopathic system are applicable as the O.M. of the dated 1-1-2008 of AYUSH procedures are extended.

(c) Re-imbursement for treatment/procedures for which prescribed rates have not been indicated in Annexure “B” will be charged as per actual. The Hospitals are not required to give medicines in OPD or at the time of discharge of the patient. Medicines so provided shall not be reimbursable. Procedures / Treatments given to the beneficiary outside the list will be discouraged if justification is not given for doing outside procedures.

(d) Ward entitlement and rates for room charges will be as prescribed earlier for CGHS beneficiaries. Room rent is applicable only for treatment procedures for which there is no prescribed package rate and will include charges for occupation of bed, diet for the patient, charges for water and electricity supply, linen charges, nursing charges and routine up-keeping. Expenses on toiletries, cosmetics, telephone bills etc. are not reimbursable and are included in rates/package rates.

(e) The prescribed rates as indicated in Annexure “B” shall be valid for the period of Memorandum of Agreement required to be signed by the Hospital/ Centre with the CGHS in general but in the present case the period is specified in the second pargraph of the O.M.The additional time taken in the MOA is meant to address any dispute arise between the parties while the activities are in operational or in case if extenion is required to be obtained from the aurhorities in exgensis.

3. The treatment at these empanelled AYUSH Hospitals/Centers may be taken only with the prior authorization/ permission in accordance with the CGHS Rules or the CS (MA) Rules as the case may be in force at the time of taking treatment.

4.        (i) In respect of the CGHS beneficiaries permission for treatment is granted by CMO In charge/ Additional Director / Joint Director, CGHS in case of pensioners, former Governors , Former Vice-president Ex-MPs, Freedom Fighters etc. and by Rajya Sabha / Lok Sabha Secretariat as the case may be in case of Members of Parliament by the Registrar General of Supreme Court and by the Registrar Delhi High Court in respect of serving employees and pensioners of case of serving Govt, employees serving employees and pensioners of autonomous bodies covered under CGHS such permission shall be issued on the basis of recommendation from CMO/SMO I/C of the concerned AYUSH dispensary.

ii) In respect of the Government employees covered under the CS (MA) Rules, authorization/permission is to be issued by the concerned administrative Ministry/Department based on the recommendations of the AMA of the concerned system of the medicine.

iii) For Yoga & Naturopathy Office Memorandum NO. 15/11-21/2009/CGHS (SZVCGHS (P) dated 27th October, 2009 which is in free will continue.

5. The AYUSH Hospitals/Centers will not refuse admission/treatment to Central Government Employees or their dependant family members who are not CGHS beneficiaries if they produce certified/ attested copies of identity cards issued by the Government of India and have been referred to the Hospital/Diagnostic centre by the organization in which they are working and shall not charge more than the prescribed package rates/ rates in such cases.

6. An AYUSH Hospital/centre empanelled as above, whose rates for treatment procedures/tests are lower than the prescribed rates shall charge as per actual.

7. (a) Hospitals shall provide credit facility to the following categories of CGHS beneficiaries (including dependant family members, whose names are entered on CGHS Card) on production of valid permission letter:

• Members of Parliament;
• Pensioners of Central Government drawing pension from central estimates;
• Former Vice-presidents, Former Governors and former Prime Ministers;
• Ex-Members of Parliament;
• Freedom Fighters;
• Serving CGHS employees;
• Serving employees of Ministry of Health & Family Welfare (including attached / subordinate offices under the Ministry of Health & Family Welfare); and
• Such other categories of CGHS cardholders as notified by the Government.

(b) Bills should be submitted to the Office of the Rajya Sabha Secretariat / Lok Sabha Secretariat in case of sitting Members of Parliament and to Additional Director. CGHS (Hqrs), Delhi / concerned CGHS city, in case of beneficiaries enlisted above, once in a month.

8. Reimbursement in case of pensioners, former Governors, former Vice-Presidents, ex-MPs, Freedom Fighters, etc.. Is made by Additional Director of concerned CGHS city through BCA and by Rajya Sabha Secretariat / Lok Sabha Secretariat in case of sitting Members of Parliament and by concerned Ministry / Department/ Organization in case of serving Govt, employees, serving employees and pensioners of autonomous bodies covered under CGHS.

9. Any legal liability arising out of such services, responsibility solely rests on the hospital and shall be dealt with by the concerned empanelled hospital/diagnostic centre. Services will be provided by the Hospitals/Diagnostic centers as per the terms of agreement

10. The Hospitals/Diagnostic centers will give a discount 5% on every cash payment charged directly from the beneficiaries.

CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay / pension. The entitlement is as follows:-

The room rent will be Rs.500/-, Rs.1000/- & Rs.1500 for General Ward, Semiprivate Ward and Private Ward. It is clarified that indoor package rates for Yoga & Naturopathy are inclusive of room rent as per entitlement of the beneficiary.

11. A hospital empanelled under CGHS, whose normal rates for treatment procedure / test are lower than the CGHS prescribed rates shall charge as per the rates charged by them for that procedure / treatment from a non-CGHS beneficiary and will furnish a certificate to the effect that the rates charged from CGHS beneficiaries are not more than the rates charged by them from non-CGHS beneficiaries.

12. Private ward is defined as a hospital room where single patient is accommodated and which has an attached toilet (lavatory and bath). The room should have furnishings like wardrobe, dressing table, bed-side table, sofa set, carpet, etc. as well as a bed for attendant. The room has to be air-conditioned.

13.Semi Private ward is defined as a hospital room where two to three patients are accommodated and which has attached toilet facilities and necessary furnishings.

14.General ward is defined as halls that accommodate four to ten patients.

15.Normally treatment in higher category of accommodation than the entitled category is not permissible. However, in case of an emergency when the entitled category accommodation is not available, admission in the immediate higher category may be allowed till the entitled category accommodation becomes available. However, if a particular hospital does not have the ward as per entitlement of beneficiary, then the hospital can only bill as per entitlement of the beneficiary even though the treatment was given in higher type of ward.

Annexure- A

LIST OF AYURVEDIC HOSPITALS APPROVED UNDER CGHS 7 C.S.(M.A) RULES

The following hospitals have been empanelled under CGHS/C.S.(M.A) Rules for Ayurvedic System from 03-07-2015

LIST OF YOGA & NATUROPATHY HOSPITALS APPROVED UNDER CGHS AND C.S.(M.A.) RULES.

The following Hospitals have been empanelled under CGHS/C.S.(M.A.) Rules for Yoga & naturopathy System from 03-07-2015

Note: the room rent will be Rs.500/-, Rs.1000/- & Rs.1500/- for General Ward, Semiprivate Ward and Private Ward. It is clarified that indoor package rates for Yoga & Naturopathy are inclusive of room rent and diet as per entitlement of the beneficiary.

Sd/-
(Dr.D.C.Joshi)
Director (CGHS)
Tel.No.011-233062800

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