Instructions for Issuance of Restricted Medicines to Beneficiaries under CGHS: Important Office Order dated 12.11.2024

F. No. Z215025/19/2024/DIR/CGHS

/I/3721886/2024
(Comp No.8281 286 )
भारत सरकार
स्‍वास्‍थ्‍य एवं परिवार कल्‍याण मंत्रालय
केंद्रीय सरकार स्‍वास्‍थ्‍य योजना

रामकृष्‍ण पुरम, दिल्‍ली
दिनांक 12-11-2024

OFFICE ORDER

Subject: Instructions for Issuance of Restricted Medicines to Beneficiaries under CGHS

In order to streamline the process of issuing restricted medicines to beneficiaries (all beneficiaries eligible for OPD services in CGHS) under the Central Government Health Scheme (CGHS), the following guidelines are issued for strict compliance by all Medical Officers:

Definition of Restricted Medicines:

1. Anti-cancer medicines (Chemotherapeutic, immunotherapeutic medicines)
2. Drugs used for the treatment of other terminal illnesses like CKD, Enzyme deficiencies, Hemophilia, rare diseases, etc.
3. Limited/Specialized use drugs with prohibitive cost eg: Intra-ocular, intra-articular injections, etc.
4. Cost of restricted medicine More than Rs. 10,000/ unit of administration or more; or Rs. 50,000/ month or more.

Standard Operating Procedure for Issue of Restricted Medicine.

• CGHS shall maintain only two lists of Restricted medicines, i.e. Online Restricted Medicines and ‘STC’ Restricted Medicines which shall be displayed on the CGHS Website for information of beneficiaries.
• Immunotherapy of Medicine shall remain in the STC Restricted Medicine list.
• CGHS shall issue guidelines for the use of STC Restricted Medicines as per established CDSCO approval/ guidelines. O/o Additional Director MSD/City shall be authorized to issue the medicine without the scrutiny of the Standing Technical Committee in case the disease is covered under the issued guideline.
• In case there are no guidelines available, or the medicine has been prescribed for an indication not covered under the guidelines, the same shall be subject to the recommendation of the Standing Technical Committee.
• In case, an STC Restricted Medicine, has been advised and approved for more than 20 cases in 6 months, the same shall be included in the Online list except for Immunotherapy Medicines.
• The application for Restricted Medicines is to be submitted by the beneficiary to the Medical Officer along with the following documents:
  1. Duly filled Restricted Medicine Form (Annexure 1) by the main cardholder.
  2. Photocopy of Prescription of treating Specialist.
  3. Authorization Letter in case the beneficiary is unable to collect the medicine in person.
  4. CGHS Issued Prescription (Print out) of Restricted Medicine.

7. The Medical Officer shall only use the Online module of the CGHS application for prescribing the Restricted Medicine. In the case of STC Restricted Medicine, the Authorised Medical Officer (CMO Drugs/ Additional Director) at the Central Store/ Medical Store shall prescribe the medicines using the online module.
8. It is reiterated that the beneficiary may submit the request for Restricted medicine to any Wellness Centre across the country, however, the beneficiary must be informed that the medicine shall be available at the concerned (based on place of indent) Medical Store/Central Store/ designated Wellness Centre.
9. The Online request shall be processed by the Medical Stores/ Central Store of the city on the same day for medicine available in the Online Restricted List.
10. In the case of STC/Offline Restricted Medicines, the use of ‘Offline Indent Vouchers’ shall be discontinued, and the applications shall only be submitted on the prescribed form along with all relevant reports chronically arranged, with copies of imaging reports if any. A separate record shall be maintained at the level of the Wellness Centre for the same.
11. The Supplier of the medicine shall supply the medicine at the Medical Store/ Central Store of the city/wellness centres as per arrangement made by the Additional Director of the City/MSD.
12. The Medicine shall be distributed by the Pharmacist using the Online module of CGHS application; at the place of supply of medicine.
13. The beneficiary shall collect the medicine from the designated place within 15 days from the date of Supply (i.e. date of receipt of the medicines in MSD/WC).

signed by
Dr Satheesh Y H
Date: 12-11-2024 16:42:51
(Dr. Satheesh Y. H.)
Director (CGHS)

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GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
DEPARTMENT OF HEALTH AND FAMILY WELFARE

RAJYA SABHA
UNSTARRED QUESTION NO. 268

TO BE ANSWERED ON 05 TH DECEMBER, 2023

CASHLESS TREATMENT FACILITIES TO CGHS BENEFICIARIES

268. SHRI RAVICHANDRA VADDIRAJU:
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) Whether Government is planning to expand cashless treatment facilities for the Central Government Health Scheme (CGHS) beneficiaries as is being done in AIIMS Delhi, PGIMER Chandigarh and JIPMER Puducherry bringing under the ambit of CGHS and proposes to include all AIIMS across the country; and

(b) If so, the details thereof and present status of its implementation of the scheme?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) & (b) As per the decision taken by the Government, Memorandums of Agreement (MoAs) have been signed by CGHS with AIIMS, New Delhi; PGIMER, Chandigarh; JIPMER, Puducherry and AIIMS located at Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, Rishikesh, Bilaspur, Rajkot, Kalyani, Bhatinda, Bibinagar, Guwahati, Deoghar and Mangalagiri; to facilitate cashless treatment/ investigation facilities to Pensioner beneficiaries and other eligible categories of CGHS beneficiaries at these premier institutions. The guidelines related to treatment of CGHS pensioner beneficiaries and other entitled class of beneficiaries at these Institutes are given at Annexure.

Annexure

The guidelines related to treatment of CGHS Pensioner beneficiaries and other entitled class of beneficiaries are as under:

• CGHS Pensioners and other beneficiaries entitled for cashless treatment like ex-MPs, ex- Governors, former Judges of Supreme Court of India , former Judges of High Courts, Freedom Fighters, etc., holding a Valid CGHS Card are eligible for cashless treatment at AIIMS.
• The validity of the CGHS card and the ward entitlement are printed on CGHS Card.
• AIIMS shall create a Special desk for CGHS beneficiaries.
• Entitled CGHS beneficiaries shall present their CGHS Card for verification at CGHS Desk.
• CGHS shall facilitate verification of card details on line from CGHS Data base in consultation with NIC.
• Entitled CGHS beneficiaries shall submit a self attested copy of CGHS Card of self. In case of treatment of a dependant family member copy of the CGHS card of self and family member shall be submitted.
• CGHS Desk at AIIMS refers the beneficiaries to OPD / Investigations / Indoor treatment as the case may be.
• Bills in physical form along with copy of CGHS card shall be submitted by AIIMS in the last week of month to the office of Addl. Director, CGHS of concerned City.
• AIIMS shall send bill to CGHS as per AIIMS rates, except in case of Room rent for Indoor treatment. Bills for room rent shall be sent to CGHS as per prescribed rates for empanelled Hospitals. The beneficiaries are eligible for indoor treatment as per their ward entitlement, as indicated on their CGHS Card.
• AIIMS shall create a separate Bank Account for CGHS beneficiaries to reimburse the bills by CGHS.
• Additional Director, CGHS of concerned City shall process the bills expeditiously and payment shall be credited into the Bank Account created by AIIMS for CGHS.
• CGHS pensioners and others eligible for cashless treatment can avail treatment without any mandatory referral from CGHS.

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मि.सं.1-20/2023 /सीजीएचएस /सं.नि.आयुश)

1/3620026/ 2023

F. No.S-11011/ 90/ 2016- CGHS/ (HEC)/ AYUSH/Pt-II.
Ministry of Health & Family Welfare
Directorate General of CGHS
Office of the Director, CGHS

CGHS Bhawan, R.K Puram
Sec-13, New Delhi-66
Dated: /09/2023

OFFICE MEMORANDUM

Subject: Clarification on the referral for CGHS beneficiaries aged 75 years & above and consultation through Video Conferencing for AYUSH system-reg.

With reference to the above mentioned subject the undersigned is directed to draw the attention to Office Memorandum vide F.No. Z.15025/ 35/ 2019/ DIR/ CGHS/ CGHS(P) dated 29.05.2019 & 27.06.2019 and clarified that the referral for 75 years and above and consultation through Video Conferencing for AYUSH system is not appropriate since as per Ayurvedic literature, many procedures are contra-indicated after 75 years of age and in certain disease conditions also.

Moreover, to examine the physical condition of the patient whether he is eligible for the therapy is to be assessed by the treating Ayurvedic physician for which consultation is necessary, which is not possible through Video Conferencing and therefore, referral by the treating Ayurvedic physician, for once, is required for taking the treatment from the AYUSH Day Care Centre for a period of approximately 7 days / 15 days.

This issues in consultation with the experts in the field.

Signed by Manoj Jain
Date: 05-10-2023 17:11:45
(Manoj Jain)
Director, CGHS

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Cashless Treatment Facilities Now Available to CGHS Beneficiaries at AIIMS New Delhi, PGIMER Chandigarh, and JIPMER Puducherry

Memorandum of Agreement signed between Central Government Health Scheme(CGHS) and Three Institutes of National Importance (INI)

CGHS beneficiaries will have direct access to state-of-the-art treatment facilities available in these medical institutions, without the hassle of making upfront payments and seeking reimbursements from CGHS

The government aims to expand the number of hospitals empaneled under CGHS to provide excellent tertiary care facilities aligned with the rising requirements of the patients: Shri Rajesh Bhushan, Union Health Secretary

Posted On: 27 JUN 2023

Through a significant and people centric move, cashless treatment facilities will now be available to CGHS beneficiaries (both serving and pensioners) at AIIMS New Delhi, PGIMER Chandigarh, and JIPMER Puducherry. The Memorandum of Agreement to this effect was signed between the three medical institutions- AIIMS, New Delhi, PGIMER, Chandigarh, and JIPMER, Puducherry, and CGHS, Ministry of Health and Family Welfare, in the presence of Shri Rajesh Bhushan, Union Health Secretary, here today.

This initiative builds upon the six previously signed MoAs on May 20, 2023, between CGHS and various All India Institute of Medical Sciences (AIIMS) located in Bhopal, Bhubaneswar, Patna, Jodhpur, Raipur, and Rishikesh.

The extension of patient care facilities at AIIMS New Delhi, PGIMER Chandigarh, and JIPMER Puducherry to CGHS beneficiaries on a cashless basis will be particularly beneficial for pensioner beneficiaries of CGHS. It eliminates the need for them to submit individual reimbursement claims and follow up for approvals. With this new initiative, CGHS beneficiaries will have direct access to state-of-the-art treatment facilities available in these medical institutions, without the hassle of making upfront payments and seeking reimbursements from CGHS. This streamlined process will save time, reduce paperwork, and expedite the settlement of individual claims. Previously, CGHS pensioner beneficiaries availing treatment at these institutions were required to make payments upfront and claim reimbursement later from CGHS.” This was stated by Shri Rajesh Bhushan, Secretary, Ministry of Health and Family Welfare at the signing of the MoA today.

The Union Health Secretary appreciated this development highlighting that CGHS is a significant service-oriented vertical of the Health Ministry through which existing and retired employees can avail medical services. He further stated, “The government aims to expand the number of hospitals empaneled under CGHS to provide excellent tertiary care facilities aligned with the rising requirements of the patients.”

Shri Bhushan further emphasized that this agreement will benefit a large segment of the population by simplifying lengthy formalities and expediting access to medical care. He also noted that this agreement will help expand the reach of CGHS services across the nation, allowing beneficiaries to avail CGHS facilities at the INIs institutions in their respective states. Additionally, CGHS has revised certain rates of treatment and medical care, further facilitating access to treatment facilities for patients.

The sailent features of this initiative are as under:

• Cashless treatment will be available in outpatient departments (OPD), investigations, and indoor treatment for CGHS pensioners and other eligible categories of beneficiaries.
   
• The three institutions will raise credit bills for CGHS pensioners and other eligible beneficiaries, and CGHS will preferably make payment within 30 days of receiving the bills.
   
• CGHS beneficiaries will be admitted only upon the production of a valid CGHS Beneficiary ID Card for treatment at these institutions.
   
• Separate Help Desks and accounting systems will be created for CGHS beneficiaries at AIIMS New Delhi, PGIMER Chandigarh, and JIPMER Puducherry.
   
•  Medicines prescribed by the doctors at these institutions, whether for OPD treatment or at the time of discharge, will be collected by beneficiaries through CGHS.
   
• CGHS beneficiaries will no longer require referrals to access healthcare facilities at these institutions.

The MoA signing ceremony was attended by Officer on Special Duty, Minister of Health and Family Welfare, Shri Sudhansh Pant, Additional Secretary, Ministry of Health and Family Welfare, and Smt. V. Hekali Zhimoni, among other senior government officials. Directors of AIIMS New Delhi, Dr. M Srinivas, Medical superintendent, PGIMER Chandigarh, Dr. Vipin Kaushal, and Director, JIPMER Puducherry, Dr. Rakesh Agrawal were also present at the MOA signing event.

MV/JJ HFW- MoA to be signed between INIs and CGHS/27^th June2023

PIB

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Government of India
Ministry of Health & Family welfare
Office of Additional Director CGHS
Fourth floor, Kendriya Sadan, Sector -9, Chandigarh-160009

No: AD/CGHS/HCO/ De-empanelment/2023- 122-126

Dated: 03.05.2023

Office Order

The following HCOs empanelled under CGHS Chandigarh are de-empanelled-for the reasons mentioned against their name.

(Dr.Ashwani Kumar)
Addition Director
C.G.H.S. Chandigarh

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F. No. S.11030/19/2023-EHS
Government of India
Ministry of Health and Family Welfare
EHS Section

Nirman Bhawan, New Delhi
Dated the March 17th , 2023.

OFFICE MEMORANDUM

Subject: Setting up of Grievance /Advisory Committee At Dispensary Level – Modification Reg.

Local Advisory Committees were set up for all CGHS dispensaries with specific composition and specific mandate in 2005 with some modifications notified in 2010. It has been seen that the functioning of these Advisory Committees has been less than satisfactory. Hence, this mechanism needs to be refined to ensure optimal functionality to facilitate seamless delivery of health care services and prompt redressal of grievances within the CGHS System. In this context the following guidelines are being issued.

2. Constitution of Local Advisory Committee (LAC) at the Health and Wellness Centre (HWC), CGHS level:

• The LAC for all Health and Wellness Centres (HWCs) across the country to have the following composition:

1. C.M.O In-Charge
2. Area Welfare Officer(s)
3. Representative from Resident Welfare Associations.
4. Representative of Pensioners
5. Representative of Local Chemist.

• This Committee shall be duly notified by the Additional Director, CGHS of the Zone. The meetings of the Committee shall be held at least once in a month and the mandate of the Committee shall be the following:

1. Disposal of the pending claims of individuals and HCOs,
2. Assessment/Evaluation of performance of Local Chemists, including Jan Aaushadhi Kendra and other systems of medicines;
3. Provision of amenities to beneficiaries (infrastructure) at the HWC,
4. Staff punctuality and behaviour towards beneficiaries,
5. Cleanliness and maintenance of the HWC,
6. Grievance Redressal of any grievance received in the grievance box of the dispensary or otherwise (on line)

• The term of the Members of LAC at Health and Wellness (HWC) level shall be as follows:

1. The term of the Members of the Committee except CMO in-charge will be for two years only and will come into effect on 1st January every alternate year.
2. No Member shall be nominated for the 2nd term.
3. Except Area Welfare Officer, who is nominated by DOPT, two Members each from Resident Welfare Association and Pensioners’ Welfare Association shall be nominated by respective Association and CMO I/C shall approach these Associations for this purpose.

• Based on the mandate above, LAC shall be responsible for taking up such tasks and adhere to such norms as prescribed here under:

1. The Committee will meet every 2nd Saturday of the month,
2. Study the grievances/suggestions received in the complaint box and record in the register in the presence of all the LAC members,
3. Should a need arise, call the complainant on phone or in the next meeting to sort out the grievances,
4. To suggest ways and means to improve the functioning of the dispensaries within the available resources,
5. To liaise with different agencies involved in the supportive services for the maintenances of the CGHS dispensaries,
6. To inform the CMO I/C about any serious patient (CGHS beneficiary) and help to organise for his/her treatment,
7. To monitor the functioning of Authorised Local Chemist/ Jan Aushadhi Pariyojana,
8. To study the stock availability in the Wellness Centre store,
9. To study the status/pendency of the claims,
10. To monitor the performance of staff and will identify the best worker on quarterly basis. His/ Her photograph will be displayed prominently in the Wellness Centre and will also be awarded certificate of appreciation by the Committee,
11. In the meetings, only local issues of the concerned dispensary shall be discussed, and the Committee shall not interfere in any policy matter, and shall not correspond directly with the authorities but through proper channel that is, Zonal Additional Director / City Additional Director / Joint Director for the same,
12. The names, addresses and telephone numbers of the Committee members to be prominently displayed in the Health and Wellness Centre,
13. Area Welfare Officer, who is also a member of the committee, will also inform the beneficiaries about the functioning of the Advisory Committee in the Area Welfare Meetings. He will also guide the beneficiaries that any complaint regarding functioning of the Wellness Centre is to be made to the Committee instead of approaching the higher authorities directly,
14. Establishment of a dedicated helpline (TOLL FREE No. 1800-208-8900) and a call log shall be maintained,
15. Record of Discussions to be maintained and pasted on the NOTICE BOARD of Wellness Centre for perusal of beneficiaries.

3. Similarly, there shall be a Zonal Advisory Committee (ZAC) at the level of Additional Director of the concerned Zone. The composition of the committee at the zonal level shall comprise of:

1. Additional Director (Zone), CGHS
2. Chief Medical Officer dealing with Reimbursement / Hospital Bills,
3. Nodal Officer for Gnevances,
4. Administrative Officer/Office Superintendent- Member Secretary,
5. Two representative of CGHS beneficiaries,
6. Representative of CGHS empanelled Hospitals/Distributor of Jan Aushadhi Pariyojana may be co-opted as needed’ and
7. Area Welfare Officer to be included on rotation basis (quarterly).

• The Zonal Advisory Committee shall be notified by the Joint Secretary (MoHFW), looking after affairs of CGHS. The ZAC meeting shall be held once in a month, preferably on the fourth Saturday.

4. The mandate of Zonal Advisory Committee shall be:

1. To examine theissues /grievances escalated post- LAC Meetings;
2. To examine and take action based on the recommendations of the local advisory committee;
3. To monitor the issue of CGHS cards;
4. To Monitor the settlement of individual medical claims and Hospital bills;
5. To monitor issues related to shifting of Wellness Centre / Major repairs of Wellness Centres in progress/ proposed;
6. To study the grievances/suggestions received in the complaint box of Zonal office / AD office and record in the register;
7. Monitoring of timely issue of Pension pay order / Family Pension and timely settlement of Gratuity and other matters related to retirement benefits;
8. To examine the complaints against the empanelled private hospitals and sort out the grievances;
9. To look into the complaints against CMOs In- charge;
10. To ensure complete adherence to the budgetary allocation and monitor expenditure on a monthly basis;
11. To invite HCOs and Labs for addressing their issues and ensure that the contents of the MoU is honoured by them in letter and spirit; and
12. To hold CGHS panchayat at Zonal level; once in 2 months where all the executive orders, office memoranda shall be shared with the beneficiaries.

5. CGHS beneficiaries are urged to make optimal usage of the LAC and ZAC for redressal of their issues and grievances.

This issues with the approval of the Competent Authority.

(Dr. Manashvi Kumar)
Joint Secretary (CGHS)
Tel. 2306 1887

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Union Health Ministry Revises CGHS Package Rates for the benefit of CGHS Beneficiaries

Referral Process under CGHS simplified; beneficiaries can now be referred through video call

Posted On: 12 APR 2023

Union Ministry of Health and Family Welfare has decided to revised the CGHS package rates for all CGHS beneficiaries. The Union Govt has also simplified the referral process under CGHS for the benefit of its employees.

After due examination of demands from stakeholders and taking into consideration the increase in costs of various components of health care, the Union Health Ministry has proposed to initially revise the CGHS package rates of consultation fees, ICU charges and room rent, as per details given under:

Revised CGHS rates:

The referral process under CGHS has also been simplified. Earlier the CGHS beneficiary had to visit the CGHS Wellness Center himself and take referral to the hospital. But now, if the CGHS beneficiary is unable to go, he can send someone on his behalf with his documents to the wellness center. The medical officer can refer the beneficiary to go to the hospital after checking the documents. Apart from this, CGHS beneficiary can also take referral through video call.

PIB

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GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 590
TO BE ANSWERED ON 9TH DECEMBER, 2022

CASHLESS FACILITIES TO CGHS BENEFICIARIES

590. DR. MANOJ RAJORIA: SHRIMATI RANJEETA KOLI: SHRIMATI SAJDA AHMED: SHRI BALAK NATH:
SHRI RAJENDRA DHEDYA GAVIT:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) the details of the total number of CGHS beneficiaries in the country, State/UT-wise including Rajasthan;

(b) the details of the beneficiaries in Sikar and Alwar in Rajasthan, district-wise;

(c) whether the Government is aware that several CGHS empanelled hospitals across the country including Rajasthan have stopped providing cashless facilities to CGHS beneficiaries due to pending dues of the Government;

(d) the list of hospitals whose payment has been put on hold/stopped during 2021-2022; and

(e) ) if so, the details thereof along with the measures taken in this regard?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (e): State/UT-wise details of the total number of CGHS beneficiaries in the country, including Rajasthan are at Annexure. There is no separate database pertaining to the districts of Sikar and Alwar. There has been a time lag on account of established procedures for processing the claims. However, the procedures are streamlined now.

Annexure

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GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA

UNSTARRED QUESTION NO: 639

ANSWERED ON: 04.02.2022

Cashless Facilities to CGHS Beneficiaries

K. Shanmuga Sundaram
P. Velusamy
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:-

(a) whether the Government is aware of the fact that several private hospitals empanelled under the Central Government Health Scheme (CGHS) decided to suspend cashless services to the beneficiaries of the health care programme;

(b) if so, the details thereof and the pending amount to be paid to the hospitals both private and Government category;

(c) whether the cashless services to Ex-Servicemen Contributory Health Scheme is also suspended by the hospitals in private sector; and

(d) the steps taken by the Government to ensure un-interrupted cashless services to the beneficiaries?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(DR. BHARATI PRAVIN PAWAR)

(a) to (d):Under the Central Government Health Scheme(CGHS), empaneled Health Care Organizations (HCOs) are required to provide cashless facilities to the eligible CGHS beneficiaries. However, there have been reports that some hospitals are not providing cashless facilities. Suitable action is taken against them whenever such cases come to notice. AMRI Hospital, Bhubneshwar, M/s Charnock Hospitals Pvt. Ltd., Kolkata, Rabindranth Tagore International Institute of Cardiac Sciences, Kolkata and Utkal Hospital, Bhubaneshwar, Fortis Healthcare Limited, Shalimar Bagh, New Delhi and Amar Eye Centre, Naveen Shahdara Delhi have submitted notice to opt out of CGHS.

Under CGHS, during the current Financial Year, HCOs’ bills worth Rs. 1200 crore (approx.) have been paid and bills amounting to Rs. 1100 crore (approx.) are received for payment.

Regarding Ex-Servicemen Contributory Health Scheme (ECHS), as per the information provided by the Ministry of Defence, 174 Health Care Organizations (HCOs) have stopped giving cashless services to ECHS beneficiaries.

Under CGHS, following steps have been taken to ensure uninterrupted cashless services to the beneficiaries:-

• (i) Adequate funds are provided to CGHS under the relevant Head of Account for clearance of hospital bills.
• (ii) Hospital Bills are regularly processed for settlement and an amount of Rs. 1200 crore (approx.) has already been paid to private hospitals during current Financial Year 2021-22.
• (iii) Additional manpower has been mobilised to expedite settlement of hospital claims.
• (iv) In June 2021, CGHS has shifted to settlement of bills in paperless mode on the IT Platform of National Health Authority which is an attached Office of Ministry of Health & Family Welfare.

As informed by Ministry of Defence, following steps have been taken for timely payment of bills to the hospitals empanelled under ECHS: –

• (i) Provision of adequate budgetary support has been made.
• (ii) Usages of IT solution for continuous monitoring for efficient processing of bills and timely payment.
• (iii) Empanelment of additional HCOs as an alternative to those who have refused services.

Source: Lok Sabha

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A. Unresolved Items of the Earlier SCM held on 7.3.2019

Item Nos. and Ministry / Deptt.:  Item No. 43/19/SC MoHFW

Subject: Grant of one-time option to CGHS beneficiaries to opt for entitlement as per their revised Pay in Pay Band.

They were given ward facility below their entitlement, determined as per last pay drawn. The request is to give them their proper entitlement based on the notional pay in the pay band, as mentioned m OM No. S.11011/ 2/ 2008-CGHS (P) dated 20.5.2009, which states that pay in the pay band means the corresponding pay m the pay band that pensioners would have drawn, had he/ she continued m service.

The decision in the Meeting of 7.3.2019: Ministry of Health & FW that the demand to grant a one-time option to pre-1.6.2009 pensioners to opt for re-determination of their ward entitlement based on their notional pay in Pay Band is not allowed.

Though the Ministry of Health & FW has informed through their letter dated 20.07.2020 that no further action is required. Staff-Side requested that based on requests/ representation s received by them, an assessment of a number of cases who would be interested m exerc1smg the proposed option has to be considered by the MHFW.

Further, Staff-Side has also asked for a review in this regard and requested the Chair to convene a meeting with the Official Side of the M/ o Health & FW.

Status as of 25.02.2021: M/ o Health vide their letter dated 25.2.2021 informed that the demand to grant a one-time option to pre-1.5.2009 pensioners to opt for re-determination of their ward entitlement ­based on their notional pay is not allowed.

Hence, the matter may be treated as closed.

Discussions/ Decision on 26.02.2021: Staff Side agreed to give data on this for consideration of the matter afresh.

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