Delegation of powers to Heads of Offices for treatment availed in emergency circumstances- relaxation of rules regarding

1967/2013/0EL/CGHS/SZ/DSZ-CGHS (P)
Government of India
Ministry of Health and Family Welfare
CGHS (P) Section

Nirman Bhavan, New Delhi
Dated the 10th December, 2015

OFFICE MEMORANDUM

Sub: Delegation of powers to Heads of Offices for treatment availed in emergency circumstances- relaxation of rules regarding.

The undersigned is directed to refer to this Ministry’s OM No. 5.12020/4/97-CGHS (P) dated 27/12/2006 and OM No. 5.14025/01/2014-MS dated 5/6/2014 vide which powers were delegated to the Head of Departments (HODs) to decide the cases of medical claims in respect of treatment obtained in emergency at private hospital/private nursing home/private clinics, subject to item-wise ceiling prescribed under CGHS/CS (MA) rules, 1944, irrespective of the financial limit on the total amount to be reimbursed.

2. The matter has been examined in this Ministry. In view of undue hardships being faced by the employees whose offices are located in far flung areas and whose HoD are at New Delhi or at any other place far away from the respective offices, if has been decided to further delegate the powers as follows:

“The Heads of Office not below the rank of Joint Secretary to the Govt.of India may decide the cases of medical claims in respect of treatment obtained in emergency at private hospital/private nursing home/private clinics, as per the item-wise ceiling prescribed under CGHS/CS (MA) rules, 1944, subject to an overall limit of Rs. 2 lakhs per case.

3. Other contents of OM No. 5.12020/4/97-CGHS (P) dated 27/12/2006 and OM No. S.14025/01/2014-MS dated 5/6/2014 will remain unchanged.

4. This issues with the approval of Additional Secretary & Director General, CGHS and shall be effective from the date of its issue.

(Sunil Kumar Gupta)
Under Secretary to the Govt. of India

Authority: CGHS Official Website

Click to view the order

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While replying to a question in Parliament today, Minster of Health & Family Welfare Shri Jagat Prakash Nadda said that to ensure that the terms and conditions of the Memorandum of Agreement are followed scrupulously by the empanelled hospitals, a monitoring cell under the aegis of a senior officer of CGHS has been established to check irregularities including exploitation of patients”,

Treatment by CGHS empanelled hospitals in emergency cases

Recently, the Government has amended the terms and conditions for empanelment of private hospital under the Central Government Health Scheme (CGHS). Now, the hospitals are empanelled as a whole, meaning that all facilities available in the hospital would be provided to CGHS beneficiaries. Disease – specific empanelment has now been stopped.

To ensure that the terms and conditions of the Memorandum of Agreement are followed scrupulously by the empanelled hospitals, a monitoring cell under the aegis of a senior officer of CGHS has been established to check irregularities including exploitation of patients. There are provisions in the MoA including issue of Show Cause Notice, issue of warning, recovery of amount charged illegally from the beneficiaries, also confiscation of part or whole of PBG (Performance Bank Guarantee), and ultimately removal from the CGHS list, that can be resorted to in appropriate cases

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No. 2-2/2014/CGl-IS. HQ/PPT/CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi

Dated: the 25th August , 2014

OFFICE MEMORANDUM

Sub- Issue of medicines / reimbursement of expenditure on investigations / treatment procedures / implants and other medical devices under CGHS- regarding

With reference to the above mentioned subject the undersigned is directed to state that this Ministry has examined the matter in detail and with a View to streamlines the procedures regarding issue of medicines, reimbursement of expenditure on investigations, treatment procedures, implants and medical devices and with a View to plug the loopholes in the system, it has now been decided that:

a) CGHS shall supply / indent only those medicines, which are included in the CGHS formulary, except for para (b) below. However, for medicines prescribed outside formulary, medicines with identical formulations and /or similar therapeutic effect may be supplied from CGHS formulary against such medicines. CGHS formulary containing 1447 generic and 622 branded medicines is available on CGHS Website at http://msotransparentnic.in/cghsnew/index.asp

b) Anti Cancer and other similar medicines are however supplied on a case to case basis. Only the medicines approved by DCGI for use in India shall be supplied. In case an Indian version is available, which is cheaper than the imported medicine, only the Indian medicine shall be supplied even if, an imported medicine has been prescribed.

c) Medicines shall be supplied for a maximum period of one month.

d)In case of CGHS beneficiaries going abroad, issue of medicines shall be restricted for a maximum period of three months.

e) CGHS shall hereinafter allow only the listed investigations / treatment procedures for which there are prescribed CGHS rates, to be under taken in CGHS empanelled diagnostic centres and hospitals.

f) Similarly, only listed implants / medical devices with a CGHS prescribed ceiling rate shall be permitted for treatment / reimbursement under CGHS.

g) In those cases where any unlisted investigation / treatment procedure is undertaken the reimbursement shall be limited to the rate of nearest similar investigation / treatment procedure under CGHS. Addl. Director of the city /zone shall take a decision based on justification in such cases, in consultation with experts in the field, if necessary.

h) In those cases where any unlisted implant / device is installed reimbursement shall be limited to the CGHS rate of nearest similar implant / device. Addl. Director of the city / zone shall take a decision based on justification in such cases in consultation with experts in the field, if necessary.

i) Registration of Mobile number with CGHS has been made compulsory as a guard against misuse of CGHS Card.

j) In order to provide a mechanism to update the investigations / treatment procedures / implants , etc., as an ongoing process , a Technical Committee is being constituted to consider inclusion / exclusion of investigations /treatment procedures / implants , etc., under CGHS.

sd/-

(RAVI KANT)
Under Secretary to Government of India
011-2306 1441

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File738.pdf

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No.S.11045/36/2012/CGHS(HEC)
Government of India
Directorate General Of Central Govt. Health Scheme

Maulana Azad Road, Nirman Bhawan,
New Delhi 110108, dated the 31st March, 2014

OFFICE ORDER

Subject: Regarding extension of validity of empanelment of All Health Care Organizations empanelled under CGHS.

Attention is drawn to the Office Memorandum issued earlier extending validity of empanelment of all health care organizations under CGHS till 31st March, 2014.

2. It has now been decided to extend the validity of empanelment of all Health Care Organizations under CGHS for further period of three months or till finalization of next empanelment of health care organizations under CGHS whichever is earlier on same terms and conditions as defined in OM on which they were empanelled earlier.

sd/-
(Dr.Sharda Verma)
Director CGHS(HQ)

Source: http://msotransparent.nic.in/cghsnew/index.asp

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a) Acute Coronary Syndromes viz. (Coronary Artery By-pass Graft or Percutaneous Trans-Luminal Coronary Angioplasty) including Myocardial Infarction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supra- Ventricular Tachycardia, Cardiac Tamponade, Acute Left-Ventricular Failure, Severe Congestive Cardiac Failure, Accelerated Hypertension, Complete Heart Block and Stokes-Adams Attack, Acute Aortic dissection.

b) Acute Limb Ischemia, Rupture of Aneurism, Medical and surgical shock and peripheral circulatory failure.

c) Cerebro-Vascular Attack, Strokes, sudden Unconsciousness, Head Injury, Respiratory failure, De-compensated Lung Disease, Cerebro-Meningeal Infection, Convulsions, Acute Paralysis, Acute Visual Loss.

d) Acute Abdomen

e) RTA (Road Traffic Accident) with injuries including fall

f) Acute Poisoning

g) Acute Renal Failure

h) Acute Abdomen in females including Acute Obstetrical and Gynecological Emergencies.

i) Heat Stroke

O.P.D. (Outdoor Patient Department) treatment and subsequent follow-up after hospitalization is not permitted in Private Hospitals and Diagnostic Centres recognized under CGHS. Exceptions for follow-up treatment are permissible in following conditions for a period of 3 to 6 months after conducting the surgical procedure, are as follows:

a. Neuro-surgery

b. Cardiac Surgery including Angioplasty

c. Cancer Surgery, Radiotherapy and Chemotherapy

d. Organ transplant viz. Kidney

e. Knee replacement.

f. RTA (Road Traffic Accident)

Source: employeesnews.in
[http://www.employeesnews.in/2014/03/list-of-emergency-conditions-in-cghs.html]

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 Government of India
Ministry of Health and Family Welfare
Department of Health and Family Welfare

Nirman Bhawan, New Delhi

PRESS RELEASE

CREDIT TO CGHS BENEFICIARIES IN EMPANELLED PRIVATE HOSPITALS TO CONTINUE

There have been reports in the Media that private hospitals on the panel of CGHS are denying credit facilities to the eligible CGHS beneficiaries for delay in settlement of hospitals bills. Lower package rates and inadmissible deductions etc. have also been reported to be the other reasons for withdrawal of agreed cashless /credit facilities.

24 out of 407 Private hospitals empanelled under CGHS decided unilaterally to discontinue credit facility to the eligible categories of CGHS beneficiaries. Show Cause Notices stand issued to these Hospitals and the empanelment of five Hospitals has been suspended for a period of six months or till further orders, whichever is earlier.

In this regard, the CGHS beneficiaries are advised not to be guided by misleading information as most of the private hospitals are continuing to extend the cashless facilities to the CGHS beneficiaries. The Ministry of Health and Family Welfare will ensure that the CGHS empanelled private hospitals continue to extend cashless /credit facilities to the eligible CGHS beneficiaries in compliance with the terms and conditions as laid down in the Memorandum of Agreement signed by them with CGHS.

Ministry of Health and Family Welfare has already taken special steps for clearance of pending hospital bills on a priority basis and the pendency of bills is almost cleared.

CGHS has already invited bids for revision of package rates through a transparent tender process, where the last date for submission of bids was 16th March, 2014. Steps are underway to conclude the tender process early.

Source : http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File670.pdf

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Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

S-11045140 /2012/CGHS/HEC/CGHS (P)

Nirman Bhawan, New Delhi
Dated the 1st October, 2012

OFFICE MEMORANDUM

Sub: Permission for treatment / investigations in respect of CGHS beneficiaries availing treatment for Diabetes, Hypertension & other Cardiac Diseases, Dialysis and Cancer.

The undersigned is directed to refer to the subject mentioned above and to state that at present the CGHS beneficiaries undergoing treatment for Diabetes, Hypertension & other Cardiac Diseases, Dialysis and Cancer require repeated investigations / treatment procedures over a period of time and as per the existing guidelines they are required to procure permission every time to get the prescribed treatment / investigations done at CGHS empanelled hospitals /diagnostic centres.

2. With a view to alleviate the inconvenience to CGHS beneficiaries in obtaining the requisite permission(s) every time, this Ministry has decided to permit issue of permission (referral) letters by competent authorities with a validity of six months from the date of issue of the original prescription for undergoing the prescribed treatment /investigation procedures to be conducted at the prescribed intervals over a period of six months as advised by a Government Specialist. The same permission (referral) letter shall be valid for undergoing the prescribed treatment procedures / investigations on multiple times during the six months, at intervals as advised by the Government Specialist.

sd-
(V.P.Singh)
Deputy Secretary to Government of India

Source: http://msotransparent.nic.in/cghsnew/index.asp

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No: S.11045/03/2013-CGHS / HEC
Government of India
Directorate General of Central Government Health Scheme
Department of Health & Family Welfare

Bikaner House Hutments, Shahjahan Road
New Delhi 110 108 dated the 11th December    2013

OFFICE ORDER

Subject : Empanelment of private hospitals, dental clinics, eye centres, diagnostic laboratories and imaging centres under CGHS Delhi & NCR.

The undersigned is directed to invite reference to the empanelment of hospitals under CGHS vide Ministry of Health and Family Welfare’s Office Memorandum No: S.11011/23/2009-CGHS D.II/Hospital Cell (Part IX) dated 14.02.2013, vide which ‘Continuous Empanelment Scheme’ for private hospitals, dental clinics, eye centres, diagnostic laboratories and Imaging Centres under CGHS was revived with a view to empanel more health care organizations for CGHS beneficiaries.

Accordingly, after following due process, a list of following hospitals, dental clinics, eye centres, diagnostic laboratories and Imaging centres have been finalized as per terms and conditions laid down in the O.M. referred to above as well as signing of MOA and execution of performance Bank Guarantee by them signifying acceptance of terms and conditions of empanelment and rates notified by CGHS in 2010 & in OM No. Misc.1002/2006/CGHS(R&H)/ CGHS (P) dated 7/2/2013.

2.    The hospitals, dental clinics, eye centres, diagnostic laboratories and Imaging Centres, which find their names in the enclosed list of health care organizations approved for empanelment under CGHS in Delhi & NCR are empanelled for a period of one year from the date of issue of this Office Order or till next new empanelment, whichever is earlier.

3.    This Office Order and the rates applicable under CGHS for hospitals, dental clinics, eye
centre, diagnostic laboratories and Imaging Centres can be downloaded from the website of CGHS, http://msotransparent.nic.in/cghsnew/index.asp.

End: As above

sd/-
[Dr. Sharda Verma]

Additional Director CGHS (HQ) ADDITIONAL LIST OF EMPANELLED HOSPITALS, EXCLUSIVE DENTAL CLINICS, EXCLUSIVE EYE CENTRES, DIAGNOSTIC LABORATORIES / IMAGING CENTRES UNDER CGHS,

DELHI &NCR: CATEGORY WISE

Sr. No.	Name of the Hospital	Specialties Empanelled for
1	Satya Bhama Hospital,  126/105, Najafgarh Road,  Nangloi, New Delhi – 41.Ph. 011-25943107, 9311116607.	General Medicine, Gynae & Obs., Orthopedics  and joint replacements, General and Laproscopic Surgery, Neurology & Neuro Surgery, Gastroenterology, Dental, Urology & Nephrology including dialysis, Eye, ENT & Laboratory & Imaging Facilities.
2	Sonia Hospital, 1, Gulshan  Park, Rohtak Road,  Nangloi, Delhi – 110041.  Ph. No. 011-30777777.	General Medicine, Gynae & Obs., Orthopedics and joint replacements, General and Laproscopic Surgery, Neurology & Neuro Surgery, Gastroenterology, Dental, Urology & Nephrology including dialysis, Eye, ENT & Laboratory & Imaging Facilities.
3	Maharaja Agrasen Hospital,  Road No. 35, West Punjabi  Bagh, Near Police Station,  New Rohtak Road, New  Delhi. Ph. No. 011-  40777555/777	General Medicine, Gynae & Obs., Orthopedics and joint replacements, Cardiology and Cardiothoracic Surgery, General and Laproscopic Surgery, Neurology & Neuro  Surgery, Gastroenterology, Dental, Urology & Nephrology including dialysis, Medical and Surgical Oncology, Eye, ENT & Laboratory & Imaging Facilities.
4	Yatharth Wellness Hospital  and trauma centre,32-  Omega-I , Greater Noida.  Helpline numbers  8800447777,8826447777	General Medicine, Gynae & Obs., Orthopedics and joint replacements, Cardiology, General  and Laproscopic Surgery, Neurology & Neuro Surgery, Gastroenterology, Dental, Urology & Nephrology including dialysis, Eye, ENT & Laboratory & Imaging Facilities.

Sr. No.	Name of the Eye Centres	Empanelled for
1	Retina Point, Q-53, Ground  Floor, Rajouri Garden, Delhi – 110027. Ph. No. 011- 25434662.	All Available Eye Care Facilities
2	Max Multi Specialty Centre, Panchsheel (A unit of Max  Health Care Institute Ltd.), N-110, Panchsheel Park, New  Delhi. Ph. No. 011-26499870.	All Available Eye Care Facilities

Sr. No.	Name of the Dental Clinics	Empanelled for
1	Professional Dentistry Multispecialty Dental Care Centre, 3427, D.B. Gupta  Road, Paharganj, New Delhi –  110055. Ph. No. 011- 23562457.	All Available Dental Care Facilities
2	Perfect 32 Dental Clinic,  Suvidha Market Netaji Nagar, New Delhi. Mob.No.9711928585	All Available Dental Care Facilities
3	Batra Dental Clinic, Shop No.6, New Municipal Double  Storey Market, Lodhi Road,  New Delhi – 110003. Ph. No. 011-24631819.	All Available Dental Care Facilities
4	Dr. Mittal Dental Care &  Implant Centre, Flat No.36,  Pocket C/12, Sector-3,  Rohini, Delhi – 110085. Ph. No. 011-43686207	All Available Dental Care Facilities
5	Bahl Dental Clinic & Implant  Centre, 21/39-B, 1st Floor,  Tilak Nagar, New Delhi -110018. Ph. No. 9810899666.	All Available Dental Care Facilities

Source: http://msotransparent.nic.in/cghsnew/index.asp

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In a good news for lakhs of beneficiaries under the Central Government Health Scheme (CGHS), the Government is in the process of revising the rates of medical procedures offered by empanelled hospitals and diagnostic centres and giving them early payment assurance to encourage more medical institutions join the scheme.

The Ministry of Health and Family Welfare has floated e-tenders for empanelment of hospitals and decided that the rates of various medical procedures would be fixed by an average of rates quoted in e-tenders instead of the old system where the lowest quotation became the rate.

Rates of all medical procedure centres under CGHS would be revised by April next year.

Not just that, the Government is also revising its policy by providing empanelled hospitals assured upfront payment of 70 per cent of the total bill within five days of its presentation and balance admissible amount within a maximum period of 30 days.

The direction for a 10 per cent deduction in case of early/cash payment to hospitals under CGHS has also been done away with, highly-placed sources in the Ministry told PTI.

“These measures will put an end to the problems of delayed payments which discourage hospitals from getting empanelled under the scheme,” a Health Ministry official said.

Under the new policy finalised by the Ministry, the category of super specialty hospitals empanelled under the CGHS has also been done away with.

“Now, hospitals, exclusive eye hospitals/centres, exclusive dental clinics and diagnostic centres shall be empanelled for all facilities available in the health care organisation as approved by National Accreditation Board for Hospitals/National Accreditation Board for Labs and the Quality Council of India and shall not be empanelled for selected specialities/facilities,” the new policy says.

The changes will help rope in more hospitals, clinics and diagnostic centres under the CGHS as many renowned and big hospitals were shying away from being empanelled under the scheme due to pending payments and low rates for medical procedures.

Sources said payments of bills amounting to around Rs 100 crore of private hospitals are pending with the government under CGHS alone, even though hospitals are crying hoarse that pending payments are to the tune of over Rs 400 crore.

Officials, however, say this huge amount is not pending under CGHS and it may include payments under ECHS, ESI and health bills of other big departments like Delhi Police and others.

Source : www.business-standard.com
[http://www.business-standard.com/article/pti-stories/govt-to-revise-rates-for-cghs-empanelled-hospitals-113122900482_1.html]

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