No. 21/26/2013-EC-X
GOVERNMENT OF INDIA
DIRECTORTE GENERAL OF WORKS
CENTRAL PUBLIC WORKS DEPARTMENT

Nirman Bhawan, New Delhi
Dated the 24th January, 2014

To
1. All the CEs/SEs/SEs(Coord.)/EEs/DDG (Hort.)/DDOH.

Subject: Reimbursement of Medical Claims-Regarding

Sir,
After repeated requests and making available of the required formalities for processing of reimbursement of medical claims, it has been observed that the medical reimbursement claims are still being received in this Directorate are forwarded/processed in a very casual manner resulting in delay in final settlement of claims of individuals and settling medical claims of different C.G.H.S. approved Hospitals.

To minimize the delay and to streamline the process of scrutinizing and submission of reimbursement of medical claims the stage wise steps required are appended below for action on the part of field units of this Directorate:-

1. The duly filled up Modified Check list for Reimbursement of Medical Claims and Medical Claims Form as per prescribed Performa.

2. The Copy of new CGHS card.

3. The Copy of Permission Letter from concerned office.

4. The Original Bills along with discharge/ Death summary from the Hospital.

5. Emergency Certificate in original from Hospital.

6. In case of death of CGHS Card Holder following documents as prescribed in modified checklist:
i. Affidavit on stamp paper by claimant.
ii. No objection from other Legal Heirs on stamp paper.
iii. Copy of Death Certificate.

7. Whether any advance was granted in the medical Reimbursement Claim? If so, provide the details of the same and under which rules the facility was allowed to applicant.

8. Whether credit facility was granted for the treatment? If so provide the details of the same. Under which rule the credit facility was allowed to serving Govt. official?

9. Medical Reimbursement Claim has to be submitted in duplicate.

10. It has to be mentioned by the forwarding /concern office (Chief Engineer) as to whether the amount claimed for reimbursement is as per the CGHS prescribed rate or not and it has also need to be certified that there is no need of any relaxation of rules in the instant case.

11. Original pouch of Stent packets along with requisite documents prescribed by MOHFW from time to time needs to be enclosed in the MRC file in order.

12. The amount mentioned for stents and other consumables may please be checked as per ceiling rates fixed by MOHFW and the same may be indicated in the forwarding letter.

13. As per the observations of IFD and Works Division in the precedent cases the case requires to be submitted in line with the guidelines of precedent cases providing the details of amount charged by the hospital indicating the S.I. No. of the CGHS items with relevant instructions and thus arriving at the amount admissible.

The case may be submitted with the details of amount charged by the hospital indicating the S.I. No. of the CGHS items with relevant instructions and thus arriving at the amount admissible as per the below format:-

(i) Name of the Hospital ……………………………… Period of treatment from ………..   to …………
(extracts of hospital recognition be placed in the file or instructions relating of treatment from non-empanelled hospital be placed in the file and it may be averred all stipulations have been complied with

(ii) All relevant OMs pertaining to the case (item wise-reimbursement) may be placed in the file alongwith the Mb o Health & Family Welfare OM No. S-11011/23/2009/CGHS D-11 dated 17th August, 2010 and subsequent clarificatory OMs issued thereafter.

(iii) It may be indicated whether 10% discount has been availed and case may be put up as per prescribed format as mentioned above.

14. Clarification regarding admissible and non-admissible items under CGHS provided in Mb o Health & Family Welfare’s O.M. No.F.No.2-1/2012/CGHSNC/CGHS(P) dated 01st August, 2013 has to be complied with.

15. As per Ministry of Health and Family Welfare’s Draft MOA F.No. D.12034/22/09/CGHS-Desk-I following has to be checked.

(i) DISCOUNT : Hospital shall also allow a discount of 10% on every cash payment.

(ii) CREDIT: On production of a valid permission by the CGHS beneficiary- the hospital shall provide credit facilities to the Members of Parliament, Pensioners, Ex-Members of Parliament, Freedom Fighters, Serving CGHS employees, serving employees of Ministry of Health & Family Welfare, serving employees of Directorate General of Health Services and such other categories of CGHS cardholders as notified by the Government. In case of emergency the hospital shall provide credit to all CGHS beneficiaries.

(iii) TREATMENT IN EMERGENCY:
In emergency the hospital shall not refuse admission or demand an advance payment from the beneficiary or his family member and shall provide credit facilities to the patient whether the patient is a serving employee or a pensioner availing CGHS facilities, on production of a valid CGHS card and the hospital shall submit the bill for reimbursement to the concerned Deptt./Ministry/CGHS. The refusal to provide the treatment to bonafide CGHS beneficiaries in emergency cases without valid ground, would attract disqualification for continuation of empanelment.

The list of ailments which may be treated as emergency has been mentioned in the MOA for the Hospitals, which is illustrative only and not exhaustive, depending on the condition of the patient.

(iv) For serving employees (other than CGHS/ DGHS /Ministry of H&FW), the payment shall be made by the patient and he shall claim reimbursement from his office subject to the approved ceiling rates. The Private Hospital shall allow a discount of 10% on all payments made in cash.

(v) The treatment procedure shall be performed on the basis of the authorization letter issued by the Chief Medical Officer of the concerned CGHS dispensary in case of pensioners and by the administrative department / ministry in case of serving employees.

(vi) The Hospital agrees that during the In-patient treatment of the CGHS beneficiary, the Hospital shall not ask the beneficiary or his attendant to purchase separately the medicines / sundries / equipment or accessories from outside and shall provide the treatment within the package deal rate, fixed by the CGHS which includes the cost of all the items. Appropriate action, including removing from CGHS empanelment and / or termination of this Agreement, may be initiated on the basis of a complaint, medical audit or inspections carried out by CGHS teams / appointed TPA.

(vii) The hospital shall not refer the patient to other specialist / other hospital without prior permission of CGHS authorities. Prior intimation shall be given to CGHS whenever patient needs further referral.

(viii) Entitlement for various types of wards to CGHS beneficiaries has also been provided in the aforesaid MOA.

This issues with the approval of DDG (HQ)

sd/-
(Rahul Ranbir Singh)
Deputy Director (Administration)

Source: www.cpwd.gov.in
[http://cpwd.gov.in/WriteReadData/other_cir/9291.pdf]

The post CPWD Orders on Reimbursement of Medical Claims under CGHS appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

GOVERNMENT OF INDIA
Ministry of Urban Development
Central Public Works Department

No.55/4/2006-S&D/897

Date 11 Nov 2013

OFFICE MEMORANDUM

Subject: Implementation of Modified Assured Career Progression Scheme (MACPS) to the cadre of Junior Engineers of CPWD.

Reference is invited to this Directorate OM of even No. 1576 dated 9.11.2010, vide which the implementation of the MACPS to the cadre of the Junior Engineers /Assistant Engineers / Adhoc Executive Engineers was kept on hold.

Subsequently, vide this Directorate OM of even No. 301 dated 25,3.2011, orders for keeping hold the implementation of the MACPS to the cadre of the Junior Engineers /Assistant Engineers / Adhoc Executive Engineers was revoked. However, the MACPS to the cadre of Junior Engineers was again kept on hold vide OM of even No. 320 dt 31.3.2011

It has now been decided to revoke above referred orders dated 31.3 2011 of keeping hold the MACPS for Junior Engineers. MACPS notified vide DoPT ref. No. 35034/3/2008-Estt(D) dated 19.5.2009 shall be implemented for this cadre.

This issues with the approval of Director General, CPWD

Source: www.cpwd.gov.in

The post CPWD Orders – Implementation of MACP to the cadre of Junior Engineers of CPWD appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.

MACPS for the cadre of Junior Engineers/Assistant Engineers in CPWD.

The last proposal was sent to DOPT for consideration on above subject have also been rejected by DOPT and intimated that running of MACPS though with one time relaxation together with ACPS for a part of the cadre is contrary to the provisions of MACP Scheme. The reply of Dopt letter is reproduced and given below for your ready reference…
Anomalous and disadvantageous provisions of MACPS for the cadre of Junior Engineers/Assistant Engineers and other similarly placed cadres of CPWD.
Consequent to non acceptance of earlier proposals on above mentioned subject forwarded to Dopt in August 2009, Jan 2010 and in Nov 2011, a further proposal for restoration of earlier Assured Career Progression Scheme with one time relaxation to opt for MACPS as on 1.9.2008, who have been granted two upgradations under ACPS, was sent to DoPT in June 2012 for their consideration and approval.

DoPT has not accepted the latest proposal also and intimated that running of MACPS though with one time relaxation together with ACPS for a part of the cadre is contrary to the provisions of MACPS and hence cannot be accepted.
In the circumstances, concerned Service Associations representing Junior Engineers/Assistant Engineers/Executive Engineers and other service Associations of CPWD are requested to intimate as to scheme (ACPS or MACPS), they would like to opt for their cadres in future. The reply may be submitted within seven days of the receipt of this letter.

Source: www.cpwd.gov.in
[http://cpwd.gov.in/]

The post DOPT rejected the proposal for restoration of earlier ACP with one time relaxation to opt for MACP appeared first on CENTRAL GOVERNMENT EMPLOYEES NEWS.