F.No.S-11011/40/2017-CGHS(HEC)
Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
(Hospital Empanelment Cell)

Maulana Azad Road Nirman Bhawan,
New Delhi 110 011, dated the 9th July, 2018.

OFFICE MEMORANDUM

Subject: Revoking suspension of empanelment of BLK Super Specialty Hospital, Pusa Road, New Delhi under CGHS
With reference to the above mentioned matter, the undersigned is to draw attention to the Office Memorandum of even Number dated 19.06.2017 vide which empanelment of BLK Super Speciality Hospital, Pusa Road, New Delhi under CGHS was suspended. In this regard the representation of the said hospital for revoking its suspension on the basis of corrective steps taken by the hospital has been examined and it is now been decided to revoke the suspension of the empanelment of BLK Super Speciality Hospital, Pusa Road, New Delhi under CGHS, w.e.f. date of issue of this order on the same terms and conditions as indicated in Office Memorandum No S-11045/36/2012-CGHS (HEC) vide which it was initially empanelled.

sd/-
(Bindu Tewari)
Director, CGHS

Source: https://cghs.gov.in/

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Govt. of India
Office of the Additional Director
Central Govt. Health Scheme
Police I.T.I. Building Jahangirabad, Bhopal

E-mail: adcghs.bpl@cghs.nic.in
Tel.No.(0755) 2550265
Fax No. (0755) 2768621

No.2(16)/Estt/CGHS/2018-19/470-83

Bhopal Dated:17th July-2018

Office Memorandum

Sub: Extension of Empanelment of Health Care Organization (HCOs) under continuous Empanelment Scheme.

In continuation of Office Memorandum of even number dated 14.7.2017 the period of empanelment of the following is extended for a period of One year w.e.f. 14.7.2018 or till next new empanelment which ever is earlier on the same terms & conditions which were signed at the time of empanelment.

Exclusive Eye Hospital/Centre Empanelled under CGHS Indore

sd/-
Additional Director
CGHS Bhopal

Source: https://cghs.gov.in

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CGHS

No. Misc.12014/2005/CGHS(R&H)

Nirman Bhawan, New Delhi
Dated the 9th July, 2018

OFFICE MEMORANDUM

Subject:- Permission /Approval for reimbursement of cost of Neuro-implants, viz., Deep Brain Stimulation implants, Intra-thecal Baclofen Pump, lntra-thecal Morphine Pump and Spinal Cord stimulators for CGHS/CS(MA) beneficiaries

With reference to the above subject the undersigned is directed to draw attention to the Office Memoranda of even Number dated 23/06/2006 and 4/12/2008 and OM No.S.3849/09/CGHS(R&H)-CGHS(P) dated 8/12/2014 vide which the rates and guidelines for Permission /Approval for reimbursement of cost of Neuro-implants, viz., Deep Brain Stimulation implants, Intra-thecal Baclofen Pump, Intra-thecal Morphine Pump and Spinal Cord stimulators for CGHS/CS(MA) beneficiaries were notified and to convey the approval of competent authority to allow reimbursement of cost of the above mentioned neuro-implants under CGHS/CS(MA) Rules at the same ceiling rates and guidelines and conditions till the rates for the above mentioned implants are notified by National Pharmaceutical Pricing Authority (NPPA).

sd/-
(Bindu Tewari)
Director (EHS)

Source: https://cghs.gov.in/

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Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
EHS Section

No.Z.15025/38/2018/DIR/CGHS/EHS

Nirman Bhawan, New Delhi
Dated the 22nd May, 2018

OFFICE MEMORANDUM

Subject: Relaxation of Rules for consideration of reimbursement in excess of the approved rates pertaining to medical claims

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office Memorandum No. 4-18/2005- C&P [Vo]. l-Pt (1)], dated the 20th February 2009 and to state that it has now been decided to modify the Para 3 (2) of the above referred Office Memorandum as per the details given under the succeeding paragraphs.

a) The requests for full reimbursement which fall under the following defined criteria shall be examined by Directorate General of CGHS and submitted to AS&DG (CGHS) for consideration of approval. After the recommendation of AS&DG (CGHS), the concurrence of Internal Finance Division and approval of Secretary, Ministry of Health & Family Welfare are required for reimbursement in excess of CGHS rates:

1) Treatment was obtained in a private unrecognized hospital under emergency and the patient was admitted by others when the beneficiary was unconscious or severely incapacitated and was hospitalized for a prolonged period.

2) Treatment was obtained in a private unrecognized hospital under emergency and was admitted for prolonged period for treatment of Head Injury, Coma , Septicemia, Multi-organ failure , etc.

3) Treatment was obtained in a private unrecognized hospital under emergency for treatment of advanced malignancy

4) Treatment was taken under emergency in higher type of accommodation as rooms as per his/her entitlement are not available during that period.

5) Treatment was taken in higher type of accommodation under specific conditions for isolation of patients to avoid contacting infections

6) Treatment was obtained in a private unrecognized hospital under emergency when there is a strike in Govt. hospitals.

7) Treatment was obtained in a private unrecognized hospital under emergency while on official tour to non-CGHS covered area.

b) The requests from CGHS beneficiaries. having a valid CGHS Card at the time of treatment, in respect of the following conditions shall be considered by a High Powered Committee constituted by Ministry of Health & Family Welfare:

(i) Settlement of medical claims in relaxation of rules

(ii) Approval for air-fare with or without attendant on the advice of treating doctor for treatment in another city even though he/she is not eligible for air travel treatment facilities are available in city of residence

(iii) Representations from CGHS beneficiaries seeking full reimbursements under special Circumstances, which are not notified.

c) The other terms and conditions mentioned in the OM No. 4-18/2005- C&P[Vol. l-Pt(1)] dated the 20 February 2009 shall remain unchanged.

sd/-
(Rajeev Attri)
Under Secretary to Government of India

Source: www.cghs.gov.in

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GOVERNMENT OF INDIA
MINISTRY OF RAILWAYS
(RAILWAY BOARD)

No.2016/H-1/11/58/Policy

New Delhi, dated 25.4.2018

The General Managers,

All Indian Railways & Production Units,

Sub: Comprehensive procedure, guidelines and check list for empanelment of private hospitals.

Ref:- SER’s letter no.CMD/SER/Hosp. Tie-up/2303 Dated 14.11.2017.

PCMD/SER vide their letter under reference had sought necessary guidelines to be followed while empanelling private hospitals in consequence of powers delegated to the GMs for empanelment of private hospitals vide Railway Board letter no. 2017/Trans/01/Policy dated 18/10/17 and to the DRM’s for divisions and CWMs for workshops vide letter no.2017/Trans/01/Policy/Pt 1 dated 30/11/17. Such powers are to be exercised by the delegated officers in person and shall not be delegated below. Hence now no proposal for empanelment is required to be sent to Railway Board.

A comprehensive guideline for procedure and checklist to be followed while empanelling private hospitals are being issued as per Annexure enclosed. Any new guidelines issued from MoH & FW as and when issued shall be duly incorporated and advised.

This is in surprise of all earlier guidelines issued from Railway Board on this subject.

This issues with the concurrence of the Finance Directorate of the Ministry of Railways.

(Mrs. H.K. Sanhotra)

Joint Director-II/Health

Comprehensive Procedure Guideline & Check List For Empanelment of Private Hospitals

The empanelled hospitals have been broadly categorised into two groups:-

A. CGHS / E$l / ECHS empanelled hospitals and Government of India / Public Sector Undertaking hospitals like of SAIL, BHEL, Coal India, etc.

B. Other private hospitals which are neither empanelled by CGHS, ECHS & ESI nor are run by Government of India Public Sector Unit. (PSU).

The following guide lines and check list are to be kept in consideration while empanelling hospitals by Railways. The point common to both these types of hospitals are given below:-

1. Justification for the proposal mentioning the present status of Railway Hospital i.e. number of Doctors & Paramedical on roll vis. a vis. sanctioned strength, services provided by it, any future plan for expansion, no. of Honorary Consultants/Visiting Specialists (specialty wise) & CMPs and despite existing facilities why referral services are still required.

2. Justification for empanelment with technical aspect i.e. number of beds/ facilities/specialties/services offered/medical set up etc. at the proposed hospital.

3. Total number of Railway beneficiaries catered by the Railway Hospital.

4. In the Specialties Specialties for which Railway hospital do not have facilities if there are any reputed Government Hospitals rendering services in those specialties.

5. In CGHS covered states/cities, hospitals should be empanelled only at CGHS rates (in case of Government of India, PSU hospital their own rate) or even lower or some discount etc offered by them. Names of the hospital empanelled by CGHS / ECHS /ESI can be obtained from respective website. Even in places not covered by CGHS, all out efforts should be made to empanel hospital on CGHS (city-specific) rates only. In case of any deviation from CGHS rates, justification to be given by MD / CMS / CMO in charge, duly concurred by Associate Finance before being approved by Competent Authority.

6. Comparative statement of package rates as well as diagnostic charges of the proposed hospital with (i) other empanelled hospitals in the city and (ii) the CGHS rates of that city or the nearest city in tabulated form.

7. Two copies of rate list of hospital duly verified by competent authority. After approval, one copy along with sanction letter to be sent to HQ for uploading on Zonal website.

8. Concurrence of the Associate Finance as applicable along with their verbatim comments

9. Proposal to be sent for approval of GM /DG (RDSO) /DRM /CAO /CWM as the case may be (both for the first time and as well as further renewals).

10. Validity of empanelment will be two years or till it is empanelled or revoked by CGHS / ECHS /.ESI whichever is earlier and for Government of India PSU hospitals too it will be for two years, Same for non CGHS / ECHS / ESI hospitals too. Overall performance of the hospital, patient’s feedback etc. to be kept in mind while extension

11. Further extension may be done with mutual consent of both parties, arid will be sanctioned by GM /DG (RDSO) /DRM /CAO /CWM as the case may be (also see para

A((a) & B(d)).

A. CGHS / ESI/ ECHS empanelled hospitals and Government of India / Public Sector Undertaking hospitals like of SAIL’ 3HEL, Coal India, etc. –

(a) In case of CGHS / ECHS / ESI empanelled & Government of India/PSU run hospitals, a letter of willingness from the hospital be obtained and can be empanelled any time Rates as and when revised by CGHS can be agreed to.

B. Other private hospitals which are neither empanelled by CGHS, ECHS & ESI

a) An open advertisement should be floated once a year or as per requirement for empanelment of private hospitals.

b) Empanelment of such hospitals should be considered only if there is no other CGHS/ ECHS / ESI nor any hospital run by Government of India – Public Sector Undertaking like SAIL, BHEL, Coal India etc. empanelled hospital, preferably within a vicinity of 5kms from the hospital already empanelled.

c) Search committee should be constituted by MD / CMS / CMO, consisting of 3 doctors of at least JAG level and they may co-opt another doctor of particular speciality when required. They will visit the hospitals and give clear justification for approving this hospital.

d) For any increase in rates, at the time of extension same should be justified by MD/CMS/CMO and concurred by Associated Finance and accepted by the concerned competent authority. If such increase in rates is more than 5%, the proposal duly justified by medical in charge and vetted by associate finance and approval of DRM /CWM in case of Division and workshops to be sent to Headquarters for sanction of General Manger. In case of headquarter controlled Central hospitals and Pus, General Manager / DG*(RDSO) will approve such proposals. However, no enhancement in rate is permissible during that period of recognition of two years.

Source: http://www.cghs.gov.in/

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Subject: Empanelment of private hospitals (including dental clinics and eye centres) and diagnostic centres under CGHS Delhi & NCR.

In continuation of this Directorate’s Office Memorandum of even no. dated 26.12.2017 regarding empanelment under continuous empanelment scheme, the undersigned is to convey that in addition to the list of the hospitals (including dental clinics & eye centres) and diagnostic laboratories already empanelled, the hospitals (including dental clinics & eye centres) and diagnostic laboratories as per the list attached (22 HCOs) have also been empanelled under CGHS in Delhi & NCR with issuance of this order. The newly empanelled hospitals (including dental clinics & eye centres) and diagnostic laboratories may be treated as included in the existing list of empanelled health care organization under CGHS on same terms and conditions as have been indicated in the Office Memorandum dated 26.12.2017.

Source: http://www.cghs.gov.in/

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“Medical Officers of CGHS can issue the same medicines to CGHS beneficiaries prescribed by the Specialists even after the expiry of the validity of the prescription in Chronic diseases”

Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS

No:Z.15025/33/2018/DIR/CGHS

Nirman Bhawan, New Delhi 110 011
Dated the 1st May, 2018

Office Memorandum

Subject: Clarification regarding issue of Medicines prescribed by Specialists beyond the period for which the medicines had been advised

With reference to the above subject the undersigned is directed to state that this Ministry is in receipt of representations from CGHS beneficiaries, particularly from Senior Citizens regarding refusal of CGHS for issue of medicines prescribed by Specialists, immediately on expiry of the period for which the prescription has been issued.

The matter has been reviewed by the competent authority in view of the difficulties faced by the CGHS beneficiaries and it is now decided that Medical Officers of CGHS can issue the same medicines to CGHS beneficiaries prescribed by the Specialists even after the expiry of the validity of the prescription in Chronic diseases, where the clinical condition is stable and CGHS shall not insist on immediate re validation by Specialists.

However, in cases of Chemotherapy and immunosuppressant treatment regular follow up from Specialists would be advisable.

These guidelines are in super session of the guidelines issued earlier on the subject.

sd/-
(Dr D.C.Joshi)
Director, CGHS

Source: Confederation

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CGHS

No Permission is required for getting listed Investigations/ Treatment Procedures done at the CGHS empanelled Diagnostic Centres/Hospitals, if prescribed by CGHS Medical Officer/ CMO Incharge or Government Hospital specialist.

Listed Investigations/Treatment Procedures prescribed by a specialist of empanelled hospital need to be endorsed by the referring CGHS Medical Officer/ CMO Incharge, however permission is not required in this case also.

For unlisted Investigations/Treatment Procedures permission is required from the AD of the City/Zone in case of pensioners and Head of Department/Office in case of serving employees. However for pensioners of Autonomous bodies the permission is to be given by the concerned department only.

Procedure for getting the investigations done by an empanelled Diagnostic centre/Hospital

The following documents are required to be submitted:

1. Self attested copy of prescription of CGHS Doctor / Government specialist
2. Copy of CGHS Card of the patient and main card holder.
3. Original Prescription and Original Cards are to be produced at the centre for verification.

Investigation can be done within 14 days of the advice only.

Procedure for getting for any treatment procedure done at an empanelled hospital

The following documents are required:

1. Self attested copy of prescription of CGHS Doctor / Government specialist
2. Copy of CGHS Card of the patient and main card holder.
3. Original Prescription and Original Cards are to be produced at the centre for verification.

Treatment procedures can be done within 3 months of the advice only.

Source: www.cghs.gov.in

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Text of MH & FW O.M. No. S-11011/6/96-CGHS (P) dated 11/7/1997.

Procedure for Referral to Recognized hospitals Simplified.

In supersession of this Ministry’s Office Memorandum of even number, dated 21/6/1996 on the above subject and keeping in view the inconvenience being faced by the CGHS beneficiaries, it has been decided that :

1. The beneficiaries will have to option of availing specialized treatment at CGHS recognized hospital of his/her choice after a specialist of CGHS/Government hospital recommends for the same. A certificate regarding non-availibility of beds in Government hospital would not be required. The terms “Government hospital” would include any hospital of a State Government/Government Departments such as Railway, Atomic Energy Commission etc., as also hospitals of Public Sector Undertakings (such as those of the Steel Authority of India Limited/Coal India Limited, etc.)

2. In non-emergency cases, once the recommendation (regarding line of treatment) of a CGHS specialist or a specialist of a hospital of Central/State Government/a Public Sector Undertaking has been obtained, the procedure for obtaining Administrative approval would be as follows:

In case of serving Government servants, after the Specialist advises a procedure in writing, the permission letter for taking such treatment in a CGHS recognized private hospital/referral hospital of choice in the same city, would be given by the parent Department/Office of the employee.

In case of Pensioners, (including Ex-MPs, Former Governors, etc.), after the initial advice of a specialist has been obtained, the permission letter for such treatment would be given by the CMO Incharge of the concerned CGHS dispensary, but the bill would be raised in the name of Additional Director, CGHS concerned, as in the case of pensioners, the payment is to be made by CGHS directorate.

In case of a medical emergency, the details of which shall be recorded in writing by the CMO Incharge of the CGHS dispensary, the CMO concerned by directly (i.e., even before specialist’s advice has been obtained) refer the CGHS beneficiary to a private recognized hospital for further management / treatment.

The expenditure to be reimbursed by the parent department/office/CGHS Directorate, as the case may be, would be restricted to the package deal rates/rates approved by the Government from time to time. The expenditure in excess of the approved rates/package deal would have to be borne by the beneficiary himself/herself.

In case the beneficiary, in spite of the facility being available in the city still chooses to get treatment in CGHS recognized institutions in another city, permission may be given, but in such cases T.A/D.A would have to be borne by the beneficiary himself/herself.

For availing treatment outside the city of residence of a beneficiary, the permission of Director/Additional Director/Joint Director of the city have to be obtained.

2. These orders will be applicable from the date of issue.

3. This issues with the approval of Joint Secretary & FA vide his Dy. No. 3110 dated 10/6/1997.

Authority: http://www.cghs.gov.in/

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No:Z.15025/74/2017/DIR/CGHS/EHS
Government Of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
EHS Section

Nirman Bhawan, New Delhi 11011
Dated the 26th September,2017

OFFICE MEMORANDUM

Subject: Revision of Ceiling Rates for Knee and Hip Implants under CGHS and CS(MA) Rules

with reference to the above mentioned subject the undersigned is directed to draw attention to this Ministry’s OM No.S.11018/1/95-CGHS (P), dated the 7th March, 1995 vide which ceiling rates for Knee and Hip implants under CGHS and CS(MA) Rules have been prescribed and to state that it has now been decided by competent authority to revise the ceiling rates and guidelines for Knee and Hip implants under CGHS and CS(MA) rules as per the details given under the succeeding paragraphs.

2. (A) PRIMARY KNEE REPLACEMENT SYSTEM

(*Ceiling Price in Rs.)

* plus GST wherever Paid or payable

(B) REVISION KNEE IMPLANT SYSTEM

(*Ceiling Price in Rs.)

* plus GST wherever paid or payable

(C) HIP IMPLANT – Rs.40,000/- + GST, wherever paid or payable

3. The rates prescribed shall be valid till further orders and are applicable to Implants of any name/category/comented/non-cemented.

4. The ceiling rates are applicable for treatment taken in government hospitals/ private empanelled hospitals/ other private hospitals.

5. Institutions such as hospitals utilizing knee implants shall specifically and separetely mention the cost of the knee implant component-wise along with its brand name, name of manufacturer/importer/batch no./specifications and other details, if any in their estimate/proforma invoice/final billing,etc.,

6. Prior permission of Competent Authority may be obtained before undergoing knee/hip Implant surgery.

7. This issues with the approval of competent authority and concurrence of Integrated Finance Division vide Dy.No.C.No.3119442, dated 30.08.2017.

Sd/-
(Sunil Kumar Gupta)
Under Secretary to the Government of India

Source: http://cghs.gov.in/

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