Expanding Central Government Health Scheme (CGHS) Network - Health Minister, Shri J P Nadda

Press Information Bureau 

Government of India

Ministry of Health and Family Welfare

Expanding Central Government Health Scheme (CGHS) Network - Health Minister, Shri J P Nadda

The criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary in a particular area is as under:-

(i) In an existing CGHS city:- For opening of a new Allopathic CGHS dispensary in an existing CGHS city, there has to be a minimum of 2000 Card holders (serving employees of Central Government and Central Civil pensioners).

(ii) Extension of CGHS to a new City:- For extension of CGHS to a new city, there has to be a minimum of 6,000 Card holders.

As the resources under CGHS are fully committed, it is not possible at present to extend CGHS network to areas that are presently not covered even with the existing criteria.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.

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NO CGHS Funds for next 2 Months

Health Ministry – Started in 1954, the CGHS — with approximately 30 lakh beneficiaries — covers retired and serving central government employees, MPs and their immediate families across 25 Indian cities.

The health ministry has no money left in the Central Government Health Scheme (CGHS) account for the next two months till funds according to the revised estimate are released. Having exhausted the Rs 1,600 crore that was initially allocated, the ministry has now asked for Rs 450 crore more.

The crisis in CGHS, one of the oldest health schemes run by the government, was precipitated by successive budget cuts, said sources.

Started in 1954, the CGHS — with approximately 30 lakh beneficiaries — covers retired and serving central government employees, MPs and their immediate families across 25 Indian cities. A total of 945 private hospitals and 165 diagnostic centres are empanelled with CGHS, which means that treatment in these hospitals for specified conditions are reimbursed by the government. Expenses at government hospitals are automatically covered for CGHS card holders.

“Funding for CGHS has been steadily going down, in 2013-14 it was Rs 1,832 crore, in 2014-15 it was Rs 1,798 crore and this year it was Rs 1,600 crore which we have exhausted. More funds will come only in January which is when the demands submitted under revised estimates are released. So the next two months will be difficult. We have asked for another Rs 450 crore for the rest of the year,” a source said. The matter was discussed at a presentation given to Health Minister J P Nadda on Tuesday, along with a host of measures to increase the beneficiary base and make transactions easier through the use of technology.

While instructions were issued to start clearing bills at one go instead of the earlier practice of 10 per cent payment in first instalment and the rest later, the ministry realises that the Rs 80-90 crore corpus that was handed out to UTIITSL for payment purposes is hardly sufficient.

“We need at least a couple of hundred crores corpus for the payments to continue without any hitch. We are looking at how to raise that money from other sources if possible,” said an official. The fund crunch hit at a time when the ministry was in the process of clearing private hospital bills to the tune of several hundred crores, pending for years. The pendency had led to a mass exodus of hospitals a couple of years ago, drastically reducing the number of private institutions empanelled with CGHS.

However, unfazed by the fund shortage, officials said this was only a “temporary phase”.

Source: The Indian Express

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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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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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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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CGHS empanelled private hospitals continue to extend cashless /credit facilities to the eligible CGHS beneficiaries

Press Information Bureau

Government of India

Ministry of Health and Family Welfare

Press Note

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. 

In this regard, the CGHS beneficiaries are advised not to be guided by such misleading information. Delay in payments in the last quarter of the financial year due to budgetary constraints is not a new phenomenon and the hospitals are aware of it. Ministry of Health and Family Welfare has taken special steps and the pendency is likely to be cleared within a week. 

CGHS has already invited bids for revision of package rates through a transparent tender process. The last date for submission of bids is 10th March, 2014. Measures have also been taken to streamline the payment related issues in the ensuing empanelment process. 

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. As per the information received by the Ministry, most of the private hospitals are continuing to extend the cashless facilities to the CGHS beneficiaries. 

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Private hospitals to stop CGHS cashless scheme from March 7

In a blow to government employees, including those who have retired, the Central Government Health Service has announced withdrawal of cashless medical service in private hospitals empanelled with the CGHS scheme from March 7. Patients will henceforth have to cough up hospital charges and later claim the amount from the government, according to the new rule.

The move will affect 50 lakh serving employees and over 30 lakh pensioners, as well as their family members. At a conservative estimate, the total number of persons affected could well be over two crore.

The move was necessary, said the Association of Healthcare Providers India (or AHPI, the nodal body of private empanelled hospitals) for a number of reasons, the main ones being CGHS owes these hospitals around Rs 200 crore in unpaid services as well as “unreasonably low” CGHS tariffs that haven’t been revised for the last four years. A doctor’s consultation fee, for example, remains Rs 58.

Also, AHPI says CGHS makes “illegal” deductions of 10% on all payments leading to losses for member hospitals. AHPI claims the amount runs up to Rs 180 crore.

In Karnataka, 20 hospitals, all in Bangalore, are empanelled with AHPI. HCG, Apollo hospitals, MS Ramaiah Memorial Hospital and Bangalore Baptist Hospital, among others, will not provide the cashless health scheme from March 7.

“When we were empanelled with the government, it was agreed upon that we will get 10% rebate on treatment charges if the government pays within seven days. But now, this deduction has been made applicable even when the amount is unpaid for years. That’s illegal. This has led to huge losses for member hospitals amounting to over Rs 180 crore over the past three years,” says Dr Alexander Thomas, CEO, Bangalore Baptist hospital, who represents AHPI in Bangalore.

Some hospitals have put up a public notice to this effect, reading, “CGHS tariffs are unreasonably low and not been revised for the last four years, threatening the very existence of the medical service providers.”

Dr Naresh Shetty of AHPI said, “The empanelled hospitals have been providing services under most difficult circumstances. They had to deal with steep hikes in electricity and water tariff, consumables, wages, taxes. We’ve been requesting a revision since June 2013 but there’s been no response.”

Official speak

The dues are just one issue. The bigger issue is that a doctor’s consultation charge of Rs 58 is appalling. The fees for several procedures are abysmally low. We don’t want to let down our beneficiaries but we have no choice. We ask the CGHS to consider the rates of the National Accreditation Board for Hospitals & Healthcare Providers. We’ve suggested that if at all CGHS were to take tender route, let CGHS decide the rates based on lowest bid received from NABH – accredited hospitals. Adopting rates like this would be logical and rational. Treating a patient can’t be made similar to selling onions and potatoes.

Source:http://timesofindia.indiatimes.com/india/Private-hospitals-to-stop-CGHS-cashless-scheme-from-March-7/articleshow/31438842.cms

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