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

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

No: Z.15025/23/2018/ DIR/CGHS

Nirman Bhawan, New Delhi 110 11
Dated the 17th June ,2019

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 draw attention to the OM Z.15025/33/ 2018/DIR/CGHS dated the 1st May 2018 and to clarify that:

i. In Chronic cases where diagnosis has been made and line of treatment has been decided by the Specialist of CGHS/Govt. /empanelled hospital, there is no need to refer the patients just for extension of validity period of prescription. The prescriptions in such cases may be repeated by the concerned doctor of CGHS Wellness Centre.

ii. Only in such cases, wherein there is a need for modification of the diagnosis and/or modification of the line of treatment, beneficiaries should be referred to the concerned specialist.

iii. However, in case of specific anti-cancer and other immune-suppressant drugs, medicines may be issued only for such periods as advised by the concerned specialists.

These orders are in supersession of all the earlier orders on the subject.

(Dr. Atul Prakash)
Director, CGHS

To

1. All Ministries/ Departments , Government of India through CGHS Website 2. Addi. DDG(HQ), CGHS, MoHFW, Nirman Bhawan, New Delhi
2. AD(HQ} , CGHS, R.K.Puram, Sector-12, New Delhi 4. All Addi. Directors/Joint Directors of CGHS
3. DDG(M) /CMO(SRA} , Dte.GHS, MoHFW, Nirman Bhawan, New Delhi
4. Rajya Sabha/Lok Sabha Secretariat, New Delhi
5. Registrar, Supreme Court of India, New Delhi
6. U.P.S.C. Dholpur House, New Delhi
7. Office of the Comptroller & Auditor General of India, Bahadur Shah Zafar Marg, New Delhi
8. Director, Department of Pension & Pensioners Welfare, Lok Nayak Bhawan, Khan Market, New Delhi
9. PPS to Secretary (H&FW)/Secretary (AYUSH)/ Secretary (HR}, Ministry of Health & Family Welfare
10. PPS to DGHS/ SS&FA /AS&DG (CGHS)/ AS&MD, NRHM/AS(H), MoHFW, New Delhi
11. MS Section, MoHFW, Nirman Bhawan, New Delhi
12. MG-II Section, Dte.GHS, Nirman Bhawan, New Delhi
13. Hospital Empanelment Cell, CGHS, MoHFW, Nirman Bhawan, New Delhi
14. CGHS-1/11/111/IV, Dte. Gen of CGHS, MoHFW, Nirman Bhawan, New Delhi
15. Estt.l/Estt.11/ Estt.111/Estt.IV Section, MoHFW, Nirman Bhawan, New Delhi
16. Admn./ Admn .11 Section, Dte.GHS, MoHFW, Nirman Bhawan, New Delhi
17. Integrated Finance Division, MoHFW, Nirman Bhawan, New Delhi
18. All Officers/ Sections/ Desks in the Ministry
19. Deputy Secretary (Civil Service News), Department of Personnel & Training, 5th Floor, Sardar Patel Bhawan, New Delhi
20. Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi
21. All Staff Side Members of National Council (JCM)
22. ED(H)/Planning, Railway Board, Ministry of Railways, Rail Bhawan, Rafi Marg, New Delhi – 110001
23. Central Organization , ECHS, Department of Ex-Servicemen Welfare, Ministry of Defence, New Delhi
24. Chairman, Employees State Insurance Corporation, Ministry of Labour & Employment, Panchdeep Bhawan, C.l.G. Marg, New Delhi-110002
25. UTI Infrastructure Technology And Services Limited, UTl-ITSL Tower, Plot No3 Sector -11, CBD Belapur, Navi Mumbai-400614
26. Hindi Section, MoHFW, Nirman Bhawan, New Delhi for providing Hindi version of this OM.
27. Guard file

Source: CGHS

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Central Organisation
ECHS Adjutant General’s Branch
Integrated Headquarters
Ministry of Defence (Army)
Maude Lines
Delhi Cantt-110010

Tele: 25683476 Mil 36833

B/49774/AG/ECHS/Referral/18

Dated: 3 Aug 2018

IHQ of MoD (Navy)/Dir ECHS (N) Air HQ (VB)/DPS
HQ Southern Command (A/ECHS)
HQ Eastern Command (A/ECHS)
HQ Western Command (A/ECHS)
HQ Central Command (A/ECHS
HQ Northern Command (A/ECHS)
HQ South Western Command (A/ECHS)
HQ Andaman & Nicobar Command (A/ECHS)

CHANGE IN SYSTEM OF REFERRAL : NO REFERRAL TO BE IN THE NAME OF ANY PRIVATE EMPANELLED MEDICAL FACILITY

Copy of GOI. DoESW letter No 18(54)/2018/WE/D(Res-1) dated 02 Aug 18 is fwd
Kindly instruct to all in your jurisdiction to follow the orders with immediate effect.

(Ravi pal kapoor)

LT Col
Jt Dir (Med)
For MD ECHS

F.No. 18(54)12018NVE/D(Res-1)
Government of India
Department of Ex Servicemen Welfare
D(WE)

New Delhi, dated 02 August. 2018

To

Managing Director
Ex-servicemen Contributory
Health Scheme Wide Line,
Maude line,
Delhi Cantt.

Subject: Change in System of Referral-No referral to be in the Name of any Private Empanelled Medical Facility.

Sir,

The undersigned is direct to state that as per the Ministry of Health & family Welfare OM No. Z15025/105/2017/DIR/CGHS/EHS dated 09.11.2017 the CGHS doctor / Government Specialist shall not refer the beneficiary to any particular empanelled hospital by name but shall specify the treatment procedure and mention “referred to any CGHS empanelled centre”

ECHS has to follow the CGHS Norms. However, it is seen that doctors at CHS Polyclinics are issuing referrals by name to specific Pvt. Empanelled Medical

In view of the above, it has been decided by the competent authority that henceforth no ECHS doctor will issue referrals by name to any Pvt. Empanelled, medical Facility. The ECHS doctors shall mention on the prescription the treatment, procedure/tests required by the ECHS beneficiary and then write as follows:

“Referred to any ECHS Empanelled Medical Facility located within the Area of Responsibility of Regional Centre, (Name of City).”

CO, ECHS and RC, ECHS will ensure that the list of Pvt. Empanelled

Medical Facilities along with the medical treatment procedures/tests for which they have been empanelled is prominently displayed on the website of ECHS, Regional Centre wise. OIC, of every Polyclinic, will be responsible for ensuring that hard copies of this list downloaded from ECHS website is kept in the Polyclinic in sufficient numbers and given to the ECHS beneficiary whenever demanded. If any change lakes place in this list, it shall be the responsibility of Director RC, ECHS concerned .o ensure display of the corrected/amended list on the website of ECHS without any delay.

5 Whenever an ECHS beneficiary approaches a Pvt. Empanelled Medical

Facility with such a referral from ECHS Polyclinic and the Pvt. Empanelled Medical Facility is not empanelled by Ministry of Defence (MoD) for the required treatment procedure / tests, it shall be the responsibility of the Pvt. Empanelled Medical Facility to inform the beneficiary that it is not empanelled for the required treatment procedure / tests. If any Pvt. Empanelled Medical Facility is found providing treatment procedure / conducting tests to such an ECHS beneficiary for which it is not empanelled, then apart from not reimbursing the expenses incurred by the Medical Facility on such treatment, action will be taken against the said ECHS Empanelled Pvt Medical Facility under the rules / as per the provisions of Memorandum of Agreement (MoA).

No ECHS Polyclinic Officer/Official/Doctor should indulge in any action force canvassing for/against any ECHS empanelled Pvt. Medical Facility.

7. The above orders shall come into force with immediate effect.

(A.K. Kern)
Under Secretary to the Government of India
Tele fax: 23014946

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No. 4-24/96-C&P/CGHS (P)/EHS
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
EHS Section

Nirman Bhawan, New Delhi.
Dated: the 7th May, 2018

OFFICE MEMORANDUM

Subject: Eligibility of Permanently Disabled Unmarried Son of a, CGHS Beneficiary to avail CGHS facility – Reg.
The undersigned is directed to refer to this Ministry’s Office Memoranda of even number dated 31.05.2007, 29.08.2007 and. 02.08.2010 vide which the entitlement of the son of a CGHS beneficiary beyond the age of 25 years was conveyed. As per the two Office Memoranda under reference, it was indicated that an unmarried son of a CGHS beneficiary suffering from any permanent disability of any kind (physical or mental) will be entitled to CGHS facility even after attaining the age of 25 years.

2. Since then this Ministry is in receipt of several representations for inclusion of more conditions in , view of modification to the PWD Act, 1995 by “The Rights of Persons with Disabilities Act, 2016 (Act No. 49 of 2016)” as notified by WHO Law and Justice, Govt. of India on 27.12.2016. The matter has been reviewed by the Ministry and it is now decided that for the purpose of extending the CGHS benefits to dependent unmarried son of CGHS beneficiary beyond 25 years of age , the definition of ‘Permanent Disability’ shall include the following conditions:

I. Physical disability:

A. Locomotor disability including

a) Leprosy cured person– suffering from loss of sensation in hands or feet as well as loss of sensation and paresis in the eye and eye-lid but with no manifest deformity or suffering from manifest deformity and paresis or having extreme physical deformity as well as advanced age which prevents him/her from gainful occupation

b) Cerebral palsy – caused by damage to one or more specific areas of the brain usually occurring before, during or immediately after birth.

c) Dwarfism– a medical genetic condition resulting inLan adult height of 147 cms or less;

d) Muscular dystrophy – a. group of hereditary genetic muscle diseases characterized by progressive skeletal muscle weakness

e) Acid attack victims – disfigured due to‘ violent assaults by throwing acid or similar corrosive substance

B. Visual impairment:

a) Blindness – where a person has any of the following conditions alter best correction:
(i) Total absence of sight or
(ii) Visual acuity less than 3/60 or less than 10/200(Snellen) in the better eye with best possible correction
(iii) Limitation of field of vision subtending an angle of less than 10 degree

b) “Low vision” means any of the following conditions:

(i) visual acuity not exceeding 6/18 or less than 20/60 upto 3/60 upto 10/200 (Snellen) in the bettereye with best possible corrections; or
(ii) limitation of the field. of vision subtending an angle of less than 40 degree upto 10 degree

C. Hearing Impairment

(a) “deaf” means persons having 70 db hearin g loss in speech frequencies in both ears;

(b) “hard of hearing” means persons having 60 db to 70 db hearing loss in speech frequencies in both ears;

D. “Speech and Language disability” – permanent disability arising out of conditions such as Laryngectomy or aphasia affecting one or more components of speech and language due to organic or neuronal causes.

II. Intellectual disability- characterized by significant limitation both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior , which cover a range of every day, social and practical skills , including, social and practical skills , including-

(a) “Specific language disabilities” a heterogeneous group of conditions Wherein there is deficit in processing language, spoken. or written, that may manifest itself as a difficulty to comprehend, speak, read, write, spell, or to do the mathematical calculations and includes conditions such as perceptual disabilities, dyslexia, dysgraphia, dyscalculia, dyspraxia and developmental aphasia

(b) “Autism spectrum disorder” – a neuro-developmental disorder typically appearing in the first three years of life that significantly affects a person’s ability to communicate, understand. relationships and relate to others, and frequently associated with unusual or stereotypical rituals or behaviour.

III. Mental behaviour

“Mental illness“- a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, capacity to recognize reality or ability to meet the ordinary demands of life, but does not include retardation.

IV. Mental Retardation

V. Disability caused due to

(a) Chronic neurological conditions such as
(i) Multiple Sclerosis
(ii) Parkinson’s disease

(b) Blood disorder
(i) Haemophila
(ii) Thalassemia
(iii) Sickle Cell Disease

VI. Multiple Dis-abilities ( more than “one of the above disabilities)- including deaf blindness

3. Bench Mark Disability– unmarried permanently disabled and financially dependent sons of CGHS beneficiaries suffering 40% or more of one or more-disabilities as certified by a Medical Board shall be eligible to avail CGHS facilities even after attaining the age of 25 years.

4. This OM will be effective from the date or its issue.

Sd/-
(Rajeev Attri)
Under Secretary to the Govt. of India

Source: CGHS.GOV.IN

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Z 15025/105/2017/DIR/CGHS/EHS

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

Nirman Bhawan, New Delhi
Dated the 9th November,2017

OFFICE MEMORANDUM

Sub: Simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rules, 1944

With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving representations for simplification of procedure for undergoing treatment at private hospitals empanelled under CGHS. The matter has been examined and it has now been decided that CGHS beneficiaries are allowed to undergo treatment at private hospitals empanelled under CGHS of specific treatment procedures listed under CGHS rate list are advised by a Specialist in a Central Government / State Govt. Specialist hospital or a CGHS Medical Officer without any requirement of any other referral (permission) letter.

2. Private empanelled hospitals shall perform the treatment on cashless basis in respect of pensioners, ex-MPs, Freedom Fighters, Regular employees {both CGHS and CS (MA) beneficiaries} of this Ministry & other categories of CGHS beneficiaries, who are presently eligible for credit facility and shall enclose the prescription issued by Government Specialist or a CGHS Medical Officer, in original (or a self-attested photocopy) along with the hospital bill submitted to the competent authorities.

3. Serving government employees shall enclose the prescription issued by a Government Specialist or a CGHS Medical Officer in original (or a self-attested photocopy), while submitting the medical claim to the concerned Ministry /department/office for reimbursement.

4. CGHS Medical Officer / Government Specialist shall not refer the beneficiaries to any particular empanelled hospital by name but, shall specify the treatment procedure and mention ‘referred to any CGHS empanelled centre’.

5.These orders are applicable only in respect of treatment procedures for which CGHS rates are available.

6.This issue with the concurrence of IFD vide FTS No. 3130849, dated 09.11.2017.

S/d,
[Sunil Kumar Gupta]
Under Secretary to Government of India
Tel- 011-2306 1986

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CGHS benefits to Defence Industrial Employees of Naval Dockyard, Central Ordinance Depot and AFMSD in Mumbai

S.11030/25/2009-CGHS(P)/EHS
Government of India
Ministry of Health and Family Welfare
EHS Section

Nirman Bhawan, New Delhi
Dated the 21st/April, 2017

OFFICE MEMORANDUM

Sub: Extension of medical facilities to Defence Industrial Employees in Mumbai- reg

The undersigned is directed to say that the matter regarding extension of CGHS facilities to the Defence Industrial Employees of Naval Dockyard, Mumbai, Central Ordinance Depot, Mumbai and AFMSD, Mumbai at par with the Defence Industrial employees who are availing CGHS facilities in stations other than Mumbai, was under examination in this Ministry.

2. The matter has been examined in this Ministry in consultation with Ministry of Defence and it has been decided to extend CGHS benefits to Defence Industrial Employees of Naval Dockyard, Central Ordinance Depot and AFMSD in Mumbai.

3. This issues with the approval of the Competent Authority.

(Sunil Kumar)
Under Secretary to the Government of India
Tel:23061436

Source: www.cghs.gov.in

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