Directions to Private HCOs empanelled under CGHS

Directions to Private HCOs empanelled under CGHS regarding simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rule, 1944

Dated: 24 109/2018

OFFICE MEMORANDUM

Sub: Directions to Private HCOs empanelled under CGHS regarding simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rule, 1944.

With reference to the above mentioned’ subject the undersigned is directed to state that this Ministry has been receiving various complaints regarding difficulties being faced by CGHS beneficiaries in getting the OPD/IPD treatment at Pvt. HCOs after valid referral from the CMO/MO/Govt. Specialist. It has been viewed very seriously by the Competent Authority.

It is observed that the CGHS beneficiaries are facing a lot of resistance from the staff/OPD manager/Doctors of the private NCOs empanelled under CGHS_ CPD timing are clubbed with General OPD or OPD for EWS, which is causing inconvenience to the CGHS beneficiaries. OPD Slot for CGHS beneficiaries is also reduced to half an hour, The CGHS beneficiaries are not allowed to seek the consultation from the Senior Doctor or their OPD, so called premium OPD.

It is reiterated that HCOs empanelled under CGHS shall adhere to the term and conditions while providing treatment/investigation facilities to the CGHS beneficiaries. The private HCOs empanelled under CGHS shall provide quality service to CGHS beneficiaries and care may be taken to avoid inconvenience, especially for the Senior Citizen, Cancer Patients and terminally ill patients. Pvt. HCOs shall avoid any discrimination to CGHS beneficiaries.

As per MOA clause No. 18 (9) discrimination against CGHS beneficiaries’ vis-å-vis general patients — “The amount of Performance Bank Guarantee will be forfeited and the CGHS shall have the right to de-recognize the Health Care Organization as the case may be. Such action could be initiated on the basis of a complaint, medical audit or inspections carried Out by the CGHS teams at random. The decision Of the CGHS will be final.

All the empanelled HCOs under CGHS Delhi/NCR are hereby warned/directed to follow the specified guidelines laid down in MOA and OMs issued by the Ministry Of Health & Family Welfare, Govt. of India from time to time, failing which the Show Cause Notice will be served and action as deemed fit shall be taken.

This issues with the approval of Competent Authority.

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Dr. Sanjay Jain Addl. Director, 

CGHS (HQ)

Source: https://cghs.gov.in

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CGHS Clarification on Package Rates

Clarification on CGHS Package Rates

F.No.C.11322/27/2018/HEC 

Government of India 

Ministry of Health & Family Welfare 

Department of Health & Family Welfare

545-A, Nirman Bhavan, New Delhi

 Dated the 11th September, 2018

Office Memorandum

Sub: Clarification regarding ‘fall clause’ for the services provided by CGHS empanelled Health Care Organizations under ‘Pradhan Mantri Jan Arogya Yojana’

With reference to the above mentioned subject the undersigned is directed to clarify that if CGHS empanelled Health Care Organizations provide health care facilities under ‘Pardhan Manri Jan Arogya Yojana‘ at rates lower than the CGHS package rates ‘the fall clause’ as mentioned under Memorandum of Agreement with CGHS shall not apply.

Issued with the approval of Competent Authority.

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(Dr.Atul Prakash) 

Director, CGHS

Authrority: https://cghs.gov.in

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Mobile Application for Feedback on CGHS Service

Mobile Application for Feedback on CGHS Service

Notice – Mobile Application for Feedback on CGHS Service

F.No.44-49/2078/MCTC/CGHS/2920-3029 Monitoring Computerization and Training Cell 

Directorate of CGHS 

CGHS Building Kalibari,

 New Delhi

Date: 21st August 2018

A Quick Response Code (QR Code) based Mobile Application has been developed for CGHS beneficiaries to submit their feedback on defined CGHS Services. QR codes will be displaced in the Wellness Centres and CGHS beneficiaries, using Mobile Application will scan the QR code and submit their feedback.

With the approval of the competent authority is has been decided that to begin with this service will be available to the beneficiaries of Wellness Centres [WCs) of Delhi only. A beneficiary can download the Application named CGHS Service Feedback’ from Google Play store on his mobile.

CGHS beneficiaries can submit their feedback on the following CGHS services:

1. Registration of beneficiary 

2. Consultation with Medical Officer 

3, Dispensing of Medicines 

4. Dressing Room services 

5, Cleanliness of Wellness Centre

6. Punctuality of Staff 

7. Behaviour of Staff

A beneficiary can provide the rating on a scale of 1- to 5 and also enter remarks on ratings less than or equal to 3. The feedback will be monitored by CGHS officials to improve CGHS services only and it is not intended to be a grievance redressal mechanism.

CMOs Incharge are requested to Download the Quick Response Code through a link in. In-charge Module named ‘Feedback QR code’ , take a print out of the same and display it in the WC for the use of the beneficiaries.

They may also ensure prominently displaying of the enclosed Notice for the benefit of beneficiaries who intend to use the Application and

Peruse the reports on the feedback available through a link named ‘QR Feedback report’in CMO In charge Module.

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Dr V K Dhiman 

Nodal Officer

View order

Authority: https://cghs.gov.in

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CGHS Reimbursement: Ceiling Rates Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft

Revision of ceiling rates for reimbursement of the cost of Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS(MA) Rules

CGHS Reimbursement: Ceiling Rates Cardiac Devices

Government of India

 Ministry of Health and Family Welfare

 Department of Health & Family Welfare 

Directorate General of CGHS Office of the Director, CGHS

No. S-11011/29/2018-CGHS(HEC)/ DIR/CGHS

Nirman Bhawan, New Delhi 

Dated the 6th August, 2018

Office Memorandum

Subject:- Revision of ceiling rates for reimbursement of the cost of Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS(MA) Rules

With reference to the above subject attention is drawn to the OM No 12034/02/2014/Misc./­CGHS D.III dated 22nd July 2014 vide which ceiling rates for reimbursement of the cost of Cardiac pacemaker, AICD, Combo-device, Rotablator and Aortic Stent Graft for beneficiaries of CGHS/CS (MA) Rules were prescribed and to state that the matter has been reviewed by the Ministry and it is decided to revise the ceiling rates as per the details given under:

2. Other terms and conditions prescribed under OM No 12034/02/2014/Misc./-CGHS D.III dated 22nd July 2014 shall remain unchanged.

3. These rates shall remain valid till the rates for the above devices are notified by National Pharmaceutical Pricing Authority (NPPA).

4. Issued with the concurrence of SS&FA, Ministry of Health & Family Welfare vide CD — 1295 dated 25.07.2018.

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Dr. Atul Prakash) 

Director, CGHS

View order

Authority: https://cghs.gov.in

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Reimbursement for CGHS Beneficiaries for Treatment in Non Empanelled Hospitals

Reimbursement for CGHS beneficiaries for treatment in non empanelled hospitals

RAJYA SABHA UNSTARRED QUESTION NO-2344

ANSWERED ON-07.08.2018

Shri Ram Kumar Kashyap (a) whether Supreme Court while disposing off Writ Petition (Civil) No. 694 of 2015 has ordered that reimbursement cannot be denied to CGHS beneficiaries even if they received treatment in a hospital not empanelled under the plan;

(b) if so, whether CGHS beneficiaries can take treatment in any hospital not empanelled under CGHS in view of the recent Supreme Court Judgement;

(c) if not, the reasons therefor; and

(d) the details of medical claims pending in CGHS Delhi South Zone, R. K. Puram, Sector-8 Dispensary for more than three years and by which date the said claims will be settled?

Read also: CGHS Empanelled Hospitals, Diagnostic Centres Search Tool

ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

(a) to (c): Hon’ble Supreme Court of India vide its Judgement dated 13th April, 2018 in the WP (Civil) No. 694 of 2015 between Shri Shiva Kant Jha Vs UoI has given directions to frame guidelines for settlement of medical claims of pensioners within 1 month and for constitution of a High Powered Committee for settlement of grievances of medical claims of pensioners. Accordingly, Office Memoranda No. Z.15025/38/2018/DIR/CGHS, dated 14.05.2018 and No. Z.15025/38/2018/DIR/CGHS/EHS, dated 22.05.2018 have been issued for fixation of timelines for settlement of medical claims of pensioners and constitution of High Powered Committee respectively.

There is already a provision under CGHS for consideration of medical expenditure incurred for treatment under emergency in non-empanelled hospitals at CGHS rates and to undergo treatment in non-empanelled hospitals at CGHS approved rates after obtaining permission from Competent Authority.

(d): No claim with proper supporting documents is pending for more than three years.

Authority: https://rajyasabha.nic.in/

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Eligibility for Joining CGHS

Eligibility for Joining CGHS

All Central Govt. employees drawing their salary from Central Civil Estimates and their dependant family members residing in CGHS covered areas.

Central Govt. Pensioners/family pensioners receiving pension from central civil estimates and their eligible dependent family members.

• Sitting and Ex-members of Parliament.
• Ex-Governors & Lt. Governors.
• Freedom Fighters.
• Ex-Vice Presidents.
• Sitting and Retired Judges of Supreme Court.
• Retired Judge of High Courts.
• Journalists accredited with PIB (in Delhi).
• Employees and pensioners of certain autonomous/statutory bodies which have been extended CGHS facilities in Delhi.
• Delhi Police Personnel in Delhi only.
• Railway Board employees
• Post and Telegraph Department employees.

More details visit https://cghs.gov.in

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Guidelines for settlement of Medical claims of pensioners and others

Guidelines for settlement of Medical claims of pensioners and others

Government of India

 Ministry of Health and Family Welfare 

Department of Health & Family Welfare 

EHS Section

No.Z.15025/51/2018/DIR/CGHS/EHS

Nirman Bhawan, New Delhi 

Dated the 6th June, 2018

OFFICE MEMORANDUM

Subject : Guidelines for settlement of Medical claims of pensioners and others-

With reference to the above subject the undersigned is to draw attention to the reused timelines and constitution of High Powered Committee in compliance of the directions of Hon’ble Supreme Court of India in their Judgement in the WP(Civil) NO 694 Of 2015 between Shiva Kant Jha Vs 001 delivered on 13th April 2018 and to state that it has been decided to issue guidelines to the Additional Directors of CGHS for implementing these decisions. The new guidelines are enclosed for perusal and compliance.

(Dr.D.C Joshi) 

Director.CGHS

Click to view Guidelines to Process

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

Relaxation of Rules for consideration of reimbursement in excess of the approved rates pertaining to medical claims – CGHS Orders

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.

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(Rajeev Attri)

 Under Secretary to Government of India

View order

Authority: www.cghs.gov.in

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Issue of Medicines to CGHS beneficiaries Prescribed by Specialists Beyond the Period

Issue of Medicines to CGHS beneficiaries Prescribed by Specialists Beyond the Period

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

“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.

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 (Dr D.C.Joshi) 

Director, CGHS

Source: Confederation

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Simplification of Referral System Procedure for CGHS Beneficiaries

Simplification of Referral System Procedure for CGHS Beneficiaries

Simplification of referral system under CGHS

F.No.Z15025/117/2017/DIR/CGHS 

Z15025/117/2017/DIR/CGHS/EHS 

Government of India 

Ministry of Health & Family Welfare 

Department of Health & Family Welfare

 EHS Section

Nirman Bhawan, New Delhi 

Dated the 15th January, 2018

Office Memorandum

Sub: Simplification of referral system under CGHS

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 CGHS beneficiaries to undertake treatment at private hospitals empanelled under CGHS. The guidelines issued earlier on referral/ permission under Office Memoranda No S 11011/6/96 -CGHS (P) dt. 11/6/97 and 02/09/99, S-12020/4/97 -CGHS (P) dt. 07/04/1999. S 1101 l/l/200-CGHS (P) dt. 10/04/2001 and RA/Cons/Hyd/09-10/CGHS-IV, dated 11/06/2010 and Z.15025/105/2017/ DIR/CGHS dt. 09/11/2017 has been reviewed and it has now been decided to revise the guidelines for consultation and treatment at CGHS empanelled private hospitals as per the details given under:

i) All CGHS beneficiaries (in all CGHS Cities) shall be permitted for seeking OPD consultation from Specialists at Private hospitals empanelled under CGHS after being referred by any Medical Officer/CMO of CGHS Wellness Centre. The referral may be mentioned on the computer generated Prescription slip. After consultation at empanelled hospitals beneficiary shall report back to concerned wellness centre, where MO/CMO would endorse listed investigation and issue medicines as per guidelines mentioned below. For unlisted investigation/treatment procedure CMO Incharge shall submit the prescription to competent authority for consideration in case of pensioner beneficiaries. Serving employees shall seek permission for unlisted investigation/treatment procedure from their department as per prevailing guidelines.

ii) The medicines prescribed by specialists shall be supplied by CGHS as per the available generic name at the CGHS Wellness Centre. In case the medicine prescribed by the Specialist is available by an alternative brand name having the same composition, it shall be supplied by the brand name available at CGHS Wellness Centre.

If, the medicine prescribed by the Specialist is not available at CGHS Wellness Centre either by generic name or alternate brand name, it shall be indented by the same brand name through Authorized Local Chemist.

iii) With reference to OM Z.15025/105/2017/DIR/CGHS dated 09/11/2017, it is clarified that the validity of the advice of Central Government /State Government Specialist / CGHS Medical officer for listed treatment procedures shall be treated as valid for three months unless mentioned otherwise and no other referral (permission) letter is required to undergo, the treatment procedure at any of the empanelled Hospitals. It is also clarified that once a specific treatment procedure (listed) has been advised by a Specialist of Central Government /State Government or a CGHS Medical officer, it is the option of CGHS beneficiary to undergo at any of the CGHS empanelled hospitals of his/her choice and it is not compulsory that Specialist /CGHS Medical officer shall refer the beneficiary for treatment to any CGHS recognized hospitals.

iv) In case of Haemo-Dialysis, the advice for treatment can be made upto six months and in such cases the advice shall be valid for upto six months.

v) In case of Radio-therapy / Chemotherapy advised by a Government Specialist the advice shall be valid for all the cycles of Radio-therapy/Chemotherapy. The specialist has to specify the specific Radio-therapy procedure. Self-attested (by beneficiary) photo-copies of the permission letter is required to be submitted.

vi) In case of post-operative follow up treatment in six conditions as specified in OM dated 10.04.2001, permission for follow-up treatment shall be required from competent authority.

vii) In case of non-listed investigations / treatment procedures permission from competent authority is required to be obtained.

2. This issues with the approval of competent authority in supersession of earlier guidelines.

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[Dharminder Singh] 

Under Secretary to Government of India

Authority: www.cghs.gov.in

Original Link: http://cghs.gov.in/showfile.php?lid=4921 

Download Link: Simplification of Referral System under CGHS

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"KIND ATTENTION CGHS BENEFICIARIES" YOU CAN ADD AADHAR NUMBER UNDER CGHS

The steps involved in Beneficiary Login and Updating Aadhar No are as follows:

1. open url cghs.nic.in

2. In the window opened click on the button ‘Click here to view Beneficiary Details‘

3. Click on the button ‘Login with Beneficiary ID‘

4. In the window opened click on the button ‘Register Here‘

5. In the window opened enter the details and click on button ‘Register‘

a) Enter the Beneficiary ID No, date of Birth and the Mobile Number.In case the details entered are matching with data in CGHS Data base a

system generated ‘One time pass word (OTP) ‘ will be sent to the registered mobile phone by SMS

b) If , there is a message “details for selected beneficiary not found” please check the details entered or contact CMO i/c of CGHS

Wellness Centre for correction of Data / Mobile Phone number in the CGHS Data base

c) In case the pass word is forgotten click on button ‘Forgot pass word’ and follow the steps.

6. Once the pass word is received, please go back to Beneficiary sign in page and login using the Beneficiary ID No and password

7. In the window that opens one of the options is ‘Update Aadhar No.’ – Please click on the button and enter the Aadhar Numbers of the family Members and save.

Source:http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File1057.pdf

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Absence of own specialists troubles CGHS patients

NAGPUR : The Central Government Health Scheme (CGHS) beneficiaries are suffering due to prolonged absence of specialists in the OPD (out patient department) clinics. They have to shuttle between CGHS clinics and the other government hospitals to consult with the specialists and yet do not get the prescribed medicines for varied reasons. The additional director general (ADG) of CGHS in city Dr D O Tikas, however, says the issue will be resolved soon as the various regulations are still evolving.

CGHS clinics in city only have specialists of medicine, eye, paediatrics, obstetrics and gynaecology and skin. For treatment of all other specialities like neuroscience, psychiatry, orthopaedics, nephrology etc the CGHS clinics refer patients to either the corporation hospitals or any other government hospital including medical colleges. Unfortunately, when they come back with the medicines prescribed by them to CGHS dispensaries, patients are mostly told either drugs are not available or they are not as per combinations and formulae permitted under CGHS scheme. They are also refused medicines on the pretext that they are expensive imported medicines or are not generic formula and so not included in the CGHS list.

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

F.No 2-2/2014/CGHS PPT/CGHS(P)

Government of India

Ministry of Health & Family Welfare

Department of Health & Family Welfare

Nirman Bhawan, Maulana Azad Road

New Delhi 110 108

Dated: the 21st October , 2014

OFFICE MEMORANDUM

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

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CGHS Order: Consultation for Senior Citizens of general Public at CGHS Wellness Centres on Pilot basis

M F.No.-156493/2014/CGHS(HQ)/56-60

Directorate General of CGHS

Office of Addl. Director (HQ), CGHS

CGHS, Building , R. K. Puaram , Sector-12

New Delhi -110022

Date-29.08.2014

Sub: Consultation for Senior Citizens of general Public at CGHS Wellness Centres on Pilot basis

OFFICE MEMORANDUM

With reference to the above mentioned subject the undersigned is directed to state that with a view to enhance inclusitivity of CGHS , it has been decided that CGHS shall provide free OPD consultation facilities to senior citizens(6O yr. and above) from general public from 1.30 PM. to 3.00 P.M. on all working days on a pilot basis at the following 20 wellness centres in Delhi with effect from the 1st September, 2014:

1. Pusa Road	11. Sahibabad
2. Darya Ganj	12. Kalkaji II
3. Chandani Chowk	13. Vasant Kunj
4. Vasant Vihar	14. Kasturba Nagar II
5. Sarojini Nagar L Block	15. Sarita Vihar
6. Sarojini Nagar S Y Block	16. Rajpur Road
7. Jangpura	17. Noida Sector – 82
8. Chanakyapuri	18. Gurgoan Sect-55
9. Pandara Road	19. Kalibari
10. Greater Noida	20. Mayur Vihar

In continuation to the above memorandum following Wellness Centres under AYUSH have also been added to the list of above Wellness Centres; now there are 26 Wellness Centres 20 Allopathic and 6 under AYUSH. The terms and conditions will remain the same for both the categories of Wellness Centres. 

AYUSH CATEGORY	WELLNESS CENTRES
AYURVEDIC	Kali Bari Janakpuri
HOMOEOPATHIC	Kalkaji ll Sector 3 R K Puram
UNANI	Sarojini Nagar
SIDDHA	Lodhi Colony

The CGHS doctors are required to maintain records separately in respect of the services provided to the senior citizens of the general public . Following guidelines may be strictly followed:

1. The timings prescribed for OPD consultation at the above WC’s is 1.30 P.M. to 3.00 P.M.

2. There should be no harassment by asking for the age proof from the Senior Citizens.

3. The doctors are required to examine the patients clinically and advise accordingly.

4. The prescription is to be made on a separate prescription slip. Computerized CGHS prescription slip will not be used for this purpose.

5. Separate records of OPD Patients attending WC may be maintained in a register.

6. Every doctor shall maintain a separate register for convenience.

7. The matter may be given due publicity by displaying this order on the notice board of the Wellness Centre.

This issues with the approval of the competent authority.

Sd/-

(Dr. D.C. Joshi)

AD(HQ)

Source:http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File756.pdf

CGHS, Delhi

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Cashless Facility to CGHS Beneficiaries

Certain CGHS empanelled hospitals have stopped providing cashless facility to the CGHS beneficiaries due to their huge amount of bills pending for payment. 23 hospitals in Delhi, Hyderabad, Bangalore and Jaipur had stopped providing credit facility alleging pendency of payment of hospital bills. Show-cause notices were issued and after review, 2 hospitals in Delhi, 2 hospitals in Bengaluru and one hospital in Jaipur were removed from CGHS panel.

There was shortfall in the budget in the last quarter of financial year 2013-14. Additional Budget under PORB was received and direct payment to hospitals (instead of payment through UTI-ITSL) up to Rs. 75 crores was made and the pendency was largely cleared by 31st March 2014.

Package rates and ceiling rates of implants are revised as per recommendations of experts from time to time. Last revision of Ceiling rates for Drug eluting stents was done on 29/04/2014.

Empanelled hospitals cannot charge more than the approved package rates and ceiling rates for implants. If any of CGHS beneficiaries wants to have any implant by a specific brand name which is having more sale price than the CGHS rates, the difference between the sale price of that particular brand and the ceiling rate under CGHS is to be borne by him.

CGHS invited e-tenders for fixation of rates (revision) and empanelment of hospitals under CGHS in different cities. Technical evaluation of the bids has been completed.

The Health Minister stated this in a written reply in the Lok Sabha here today.

Source: PIB

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Plight of Central Government Pensioners not covered under CGHS.

Shiva Gopal Mishra

Secretary

Ph.: 23382286

National Council (Staff Side)

Joint Consultative Machinery

for Central Government Employees

13-C, Ferozshah Road, New Delhi – 110001

E Mail: nc.jcm.np @ gmail.com

No. NC-JCM-2014/Health-FMA

July 14, 2014

Dr. Harsh Vardhan,

Union Health Minister,

Nirman Bhawan,

New Delhi

Sir,

We bring to your kind notice the sad plight of Central Government Pensioners who are residing in areas not covered under CGHS but have obtained CGHS Card from the nearest CGHS wellness Centre. They are therefore paid a paltry sum of Rs. 300/- pm by way of Fixed Medical Allowance in lieu of outdoor patient care.

2. Taking specific case of a beneficiary we find that whereas he has paid CGHS contribution @ Rs.2700 p.a., he is getting Fixed Medical Allowance of Rs. 3600/- p. a. In other words he is getting net fixed medical allowance of Rs. 900/- p.a (3600-2700) i. e. @ Rs.75/- pm instead of Rs.300/-.

3. At present doctors consultation fee is Rs.500/- and on second day he charges Rs.200/- after obtaining medical test reports etc and then prescribes medicines which may cost any amount ranging from Rs.1000/- to Rs.3000/- pm.

4. As against Rs.75/- pm in lieu of outdoor treatment a pensioner beneficiary has to spend amounts ranging from Rs.1700 to Rs. 3700 towards outdoor treatment of usual ailments affecting on old age like gastric troubles, Blood Pressure, Diabetes, Arthritis, Heart deceases, UTI Infection and Prostate etc.

5. We have given the above details to make out a case that fixed medical allowance is too meagre to cover the outdoor treatment expenses of Central Government pensioner’s beneficiary of CGHS residing away from CGHS Centers.

6. As against this, a Central Government Pensioner who is living in CGHS station and is CGHS beneficiary is getting outdoor consultation and medicines free on payment of CGHS contribution ranging from Rs. 2700 to Rs. 3500 or so.

7. Therefore there is a clear case of glaring discrimination between C.G. Pensioner living in CGHS station and one who is living in areas out of CGHS jurisdiction. Should this discrimination not end ?

8. We also learnt that Labour Ministry has sanctioned FMA @ Rs.2000/- pm (revising it from Rs.1200/-) which is somewhat realistic reasonable amount.

9. We therefore submit for your kind consideration a proposal that the Fixed Medical Allowance may be increased to Rs.2000/- pm.

10. Will you kindly spare some time to meet us and thus give us an opportunity to explain the said plight of Central Government Pensioners beneficiaries of CGHS living away from CGHS Centre and persuade you to get the FMA increased to Rs.2000/- pm.  In present day trend of ever increasing rates of medicines, there is also a case for grant of D.A. on FMA @ Rs.2000/- pm.

Thanking you,

Yours faithfully

Sd/-

(Shiva Gopal Mishra)

Secretary

Source:http://ncjcmstaffside.com/2014/plight-of-central-government-pensioners-not-covered-under-cghs/

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CGHS Order 2014:Issue of medicines to CGHS beneficiaries at the time of discharge from empanelled private hospitals - regarding.

No. S 11011/09/2014 - CGHS (HEC) / CGHS (P)

Government of India

Ministry of Health & Family Welfare

Department of Health and Family Welfare

CGHS (Policy) Division

Nirman Bhawan, New Delhi

Dated: the 20th June, 2014

OFFICE MEMORANDUM

Sub:- Issue of medicines to CGHS beneficiaries at the time of discharge from empanelled private hospitals - regarding;

With reference to the above mentioned subject, the undersigned is directed to state that this Ministry has been receiving representations regarding difficulties being faced by CGHS beneficiaries in getting medicines immediately after discharge from empanelled private hospitals.

2. The matter has been examined in the Ministry and with a view to alleviate the inconvenience to CGHS beneficiaries in getting medicines immediately after discharge from empanelled private hospitals, it has been decided that CGHS beneficiaries who had taken inpatient medical treatment from a CGHS empanelled private hospital will be issued medicines from the treating private hospital at the time of discharge, for a period upto seven (7) days. The hospital will raise bill for the medicines separately and submit it alongwith the hospital bill for inpatient treatment, to CGHS for reimbursement in case of pensioner beneficiaries who are entitled to avail cashless medical treatment at the hospital.

3. in case of serving CGHS beneficiaries, if the treatment is provided by the hospital on credit basis (in deserving cases), they may raise bills for medicines supplied to the patient for post hospitalization period (upto 7 days after discharge), and claim reimbursement from the department / office concerned alongwith the hospital bill for inpatient treatment. In other cases, where the inpatient treatment is provided to serving CGHS beneficiaries on payment basis, the empanelled private hospital will supply medicines for upto 7 days period on payment basis, for which employee can claim reimbursement from his/her office. However, it will be upto the serving CGHS beneficiary to purchase the prescribed medicines from the hospital at the time of discharge (for upto 7 days) or get it from a CGHS dispensary, as may be convenient to him.

4. The above facility will however, be subject to the following conditions:

(i) Only essential medicines in generic form for continuity of treatment will be issued by the hospital.

(ii) No Nutritional supplements, tonic, cough syrup, vitamins, injections will be issued by the hospital. These are not allowed.

(iii) No non-drug items / equipments / appliances will be issued.

(iv) Total cost of such medicines issued by the hospital must not exceed Rs. 2000/- in any case.

5. This Office Memorandum shall come into force from the date of issue.

6. This issues with the concurrence of IFD vide FTS no. 88285 dt. 13/6/2014

Sd/-

(V. P. SINGH)

Director

Source:http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File705.pdf

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RENEWAL OF EMPANELMENT OF HOSPITALS / DIAGNOSTIC LABS / IMAGING CENTRES UNDER CGHS

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/writereaddata/cghsdata/mainlinkfile/File675.pdf

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Guidelines for issue of medicines to CGHS beneficiaries from CGHS Wellness Centres - reg.

S 11011/2/2014-CGHS (P)

Government of India

Ministry of Health and Family Welfare

CGHS (Policy) Division

Nirman Bhawan, New Delhi

Dated; the 28th March, 2014

OFFICE MEMORANDUM

Subject: Guidelines for issue of medicines to CGHS beneficiaries from CGHS Wellness Centres - reg.

The undersigned is directed to refer to this Ministry’s O.M No.S.11011/8/99-CGHS (P) dated 13.10.1999 vide which CMO In-charge of CGHS dispensaries have been permitted to issue medicines for a maximum period of 3 (three) months at a time against a valid prescription of Government specialist to CGHS beneficiaries suffering from chronic illness like diabetes, tuberculosis, heart ailment, hypertension, I.H.D,epilepsy, etc.

2. This Ministry has been receiving representations from beneficiaries regarding the requirement of fresh consultation with Government specialist every three months for re-issue of the prescribed medicines. Requests have been received from beneficiaries to relax this condition as getting an appointment with Government specialists is difficult, especially for the old aged and physically challenged beneficiaries suffering from chronic diseases and requiring constant medication.

3. Acknowledging the difficulties being faced by the beneficiaries in obtaining prescription of Government specialist every three months, it has been decided to clarify that the CMO In-charge of CGHS Wellness Centres are competent to revalidate the prescription on the request of patient, after professionally satisfying himself / herself about the medical condition of the patient and repeat the medicines prescribed by Government specialist to beneficiaries for another three months subject to the following conditions :-

a) Medicines shall be issued against a valid original prescription from a Government specialist for advising the same.

b) CMO I/c may issue the medicines prescribed by a Government specialist fix three months at a tine during the entire treatment period indicated clearly (e.g., six months / one year) on the prescription.

c) CMO I/c may examine and advise the patient on whether to continue with the same medicines as prescribed by the Government specialist or may refer him to the Government specialist for fresh consultation, If required medically.

d) CGHS GDMOs of the Wellness Centre may prescribe routine diagnostic tests to the patients before their follow up consultation with the specialist. They should however, use discretion and not to advice specialized tests/investigations as they can only be advised by the specialists, wherever required.

e) Beneficiaries will be issued medicines for maximum three months period at a time. In such cases, where the advice of specialist is only for three months and the CMO I/c is satisfied after professional examination that the same medicines are required to be continued for treatment, the prescription may be re validated and medicines can be issued for another 3 (three) months, i.e., to a total of 6 (six) months. After six months, the beneficiaries will have to consult the Government specialist and obtain fresh prescription or get the prescription re validated from the Government specialist in cases where the treatment period is not clearly indicated on the prescription.

4. This issues with the approval of Additional Secretary and Director General, CGHS.

Sd/-

(V.P.Singh)

Deputy Secretary to the Government of India

Source:http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File674.pdf

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Credit to CGHS Beneficiaries in Empanelled Private Hospitals to Continue

Press Information Bureau

Government of India

Ministry of Health and Family Welfare

Press Note 

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. 

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