CGHS Hospitals under surveillance by the aegis of CGHS Officer to check irregularities including exploitation of patients

CGHS Hospitals under surveillance by the aegis of CGHS Officer to check irregularities including exploitation of patients

While replying to a question in Parliament today, Minster of Health & Family Welfare Shri Jagat Prakash Nadda said that to ensure that the terms and conditions of the Memorandum of Agreement are followed scrupulously by the empanelled hospitals, a monitoring cell under the aegis of a senior officer of CGHS has been established to check irregularities including exploitation of patients”,

Treatment by CGHS empanelled hospitals in emergency cases

Recently, the Government has amended the terms and conditions for empanelment of private hospital under the Central Government Health Scheme (CGHS). Now, the hospitals are empanelled as a whole, meaning that all facilities available in the hospital would be provided to CGHS beneficiaries. Disease – specific empanelment has now been stopped.

To ensure that the terms and conditions of the Memorandum of Agreement are followed scrupulously by the empanelled hospitals, a monitoring cell under the aegis of a senior officer of CGHS has been established to check irregularities including exploitation of patients. There are provisions in the MoA including issue of Show Cause Notice, issue of warning, recovery of amount charged illegally from the beneficiaries, also confiscation of part or whole of PBG (Performance Bank Guarantee), and ultimately removal from the CGHS list, that can be resorted to in appropriate cases

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CGHS orders on issue of medicines, reimbursement of expenditure on investigations, treatment procedures, implants and other medical devices under CGHS

CGHS orders on issue of medicines, reimbursement of expenditure on investigations, treatment procedures, implants and other medical devices under CGHS

No. 2-2/2014/CGl-IS. HQ/PPT/CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, New Delhi

Dated: the 25th August , 2014

OFFICE MEMORANDUM

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

With reference to the above mentioned subject the undersigned is directed to state that this Ministry has examined the matter in detail and with a View to streamlines the procedures regarding issue of medicines, reimbursement of expenditure on investigations, treatment procedures, implants and medical devices and with a View to plug the loopholes in the system, it has now been decided that:

a) CGHS shall supply / indent only those medicines, which are included in the CGHS formulary, except for para (b) below. However, for medicines prescribed outside formulary, medicines with identical formulations and /or similar therapeutic effect may be supplied from CGHS formulary against such medicines. CGHS formulary containing 1447 generic and 622 branded medicines is available on CGHS Website at http://msotransparentnic.in/cghsnew/index.asp

b) Anti Cancer and other similar medicines are however supplied on a case to case basis. Only the medicines approved by DCGI for use in India shall be supplied. In case an Indian version is available, which is cheaper than the imported medicine, only the Indian medicine shall be supplied even if, an imported medicine has been prescribed.

c) Medicines shall be supplied for a maximum period of one month.
d)In case of CGHS beneficiaries going abroad, issue of medicines shall be restricted for a maximum period of three months.

e) CGHS shall hereinafter allow only the listed investigations / treatment procedures for which there are prescribed CGHS rates, to be under taken in CGHS empanelled diagnostic centres and hospitals.

f) Similarly, only listed implants / medical devices with a CGHS prescribed ceiling rate shall be permitted for treatment / reimbursement under CGHS.

g) In those cases where any unlisted investigation / treatment procedure is undertaken the reimbursement shall be limited to the rate of nearest similar investigation / treatment procedure under CGHS. Addl. Director of the city /zone shall take a decision based on justification in such cases, in consultation with experts in the field, if necessary.

h) In those cases where any unlisted implant / device is installed reimbursement shall be limited to the CGHS rate of nearest similar implant / device. Addl. Director of the city / zone shall take a decision based on justification in such cases in consultation with experts in the field, if necessary.

i) Registration of Mobile number with CGHS has been made compulsory as a guard against misuse of CGHS Card.

j) In order to provide a mechanism to update the investigations / treatment procedures / implants , etc., as an ongoing process , a Technical Committee is being constituted to consider inclusion / exclusion of investigations /treatment procedures / implants , etc., under CGHS.

sd/-

(RAVI KANT)
Under Secretary to Government of India
011-2306 1441

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File738.pdf

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CGHS Orders – Empanelment of private hospitals (including dental clinics and eve care centres) & Imaging Centre under CGHS Jabalpur.

CGHS Orders – Empanelment of private hospitals (including dental clinics and eve care centres) & Imaging Centre under CGHS Jabalpur.

GOVERNMENT OF INDIA
MINISTRY OF HEALTH & FAMILY WELFARE
OFFICE OF THE ADDITIONAL DIRECTOR
CENTRAL GOVT. HEALTH SCHEME
1544/A NAPIER TOWN
JABALPUR

No.6-8/13-Estt/CGHS/JBP/ 2101-13

Dated:-24.07.2013

OFFICE MEMORANDUM

Subject: Empanelment of private hospitals (including dental clinics and eve care centres) & Imaging Centre under CGHS Jabalpur.


In reference to (I) the Ministry of Health & F.W. O.M. No. S.11011/23/2009-CGHS D.II/ Hospital Cell(Part IX) dated 14.02.2013 vide which the ‘Continuous Empanelment Scheme’ for private hospitals and diagnostic centres under CGHS was revived and (ii) Dte. General of CGHS Office Order No. S.11045/23/2013/CG HS D-ll(HEC)/CGHS(P)/(Pt.) dated 15.07.2013, vide which powers for empanelment & issuance of notifications have been delegated to all the ADs/JDs in respect of their respective CGHS cities, a list of additional private hospitals (including dental clinics and eye centres) and Imaging Centre has been finalized for a period of one year from the date of issue of this O.M. or till the next new empanelment, whichever is earlier. This list has been finalized after following the due process and terms & conditions as laid down in the O.M. dated 14.02.13 as well as signing of MOA and execution of Performance Bank Guarantee by them signifying acceptance of the terms and conditions of empanelment and rates notified under CGHS in 2010/2011 and subsequent orders.

2. The list of empanelled hospitals (including dental clinics and eye centres) and Imaging Centre is enclosed herewith.

3. This list is in addition to the list of hospitals (including Eye Care Centres and Dental Clinics), diagnostic laboratories and imaging centres issued vide Ministry of Health & F.W. OM dated 22.03.11, 12.07.11, 27.07.11, 8.9.11, 1.11.11, 16.11.11 & 5.1.12 for Jabalpur.

sd/-
Additional Director
CGHS, Jabalpur

Annexure-I
CGHS JABALPUR

List of hospitals for All available facilities  On CGHS panel as on 31.03.2013, now enlisted with additional facilities  NABH, Applied For
SI.No.	Name of Hospital	Specialities empanelled for
1.	Jabalpur Hospital & R.Centre, Russel Chowk, Jabalpur. Tel.No.2450761-62	Interventional Cardiology Cath procedures, Cardiovascular and Thoracic surgery procedures, Non-Invasive Cardiology procedures, Internal medicine, Neurology, Neurosurgery, Paediatric Neonatology, Paediatric Surgery, Urology, Nephrology & Haemodialysis, General Surgery & Laparoscopic Surgery, Orthopaedic & Joint Replacement Surgery, Dental Oral & Maxi lofacial Surgery, Orthodontic Surgery, Gynaecology & Obstetrics, Ophthalmology, IOL Implantation, ENT, Skin and VD, Gastroenterology & Endoscopies, Anaesthesia and pain clinic, Radiology & Imaging & CT Scan, Pathology & Blood Bank, Physiotherapy, medical oncology and chemotherapy, Oncosurgery.
2.	Metro Hospital & Cancer Research Centre, (A Unit of Satya Sai Cancer Society) Kuchaini Parisar, Near Damoh Naka Bus Stand, Jabalpur. Tel. No. 2641661, 4062000.	General Medicine, General Surgery and Specialized purpose in Neurology & Neuro surgery, Urology and Nephrology including Dialysis, Orthopaedic Surgery including Joint Replacement & Arthroscopy, Gastroenterology and G.1. Surgery, Paediatrics and Paediatrics Surgery, Obstetrics and Gynaecology, Endoscopic/Laparoscopic Surgery, Opthalmology, Dental, ENT, Physiotherapy, Oncology (Medical & Surgical, Radiotherapy, Chemotherapy), Cardiology, Cardiovascular and Cardiothoracic Surgery, Diagnostic and Imaging Centre (CT, USG, X-ray & Pathology)

List of Imaging Centres  On CGHS panel as on 31.03.2013, now enlisted with additional facilities  NON-NABL (Not Applicable for Imaging Centre)
SI.No.	Name of Centre	Specialities empanelled for
1.	MP MRI And CT Scan Centre(A Unit of Sanya Hospital and Diagnostics Pvt, Ltd. Delhi) NSCB Medical College Campus Jabalpur Tel.No.0761- 2673130, 4027200	CT Scan & MRI

Annexure-II

 CGHS JABALPUR

Additional list of New Hospitals for All available facilities  NABH Applied For
SI.No.	Name of Hospital	Specialities empanelled for
1.	Mahakoshal Hospital Opp. Gate No. 03 Wright Town Stadium Jabalpur Tel. 2401909, 2610480,4064780	Medicine, Plastic Surgery & Burn, General Surgery & Laparoscopic Surgery, Opthalnriology, Gynae & Obst. Anaesthesia and pain clinic, Neurology, Neurosurgery, Oncology, Onco Surgery, Paediatrics & Paediatric Surgery, Urology, Nephrology including Dialysis, Respiratory Medicine, ENT, Psychology, Psychiatrics, Physiotherapy. Diagnostic & Imaging
2.	Aditya Super Speciality Hospital & Trauma Centre Opp. Little Kingdom School, MLB School Road Napier Town. JEW Tel. 4218312-13	Trauma & Joint Replacement, Neurology, Neuro Surgery, Minimally invasive Brain & Spine Surgery, Pain Clinic, Arthroscopy, Uro Surgery, GI Surgery, Gastroenterology, General Surgery, Plastic Surgery, Cardiology, Internal Medicine, Obst. & Gynaecology, Opthalmology, Pulmonology, ENT, Dermatology, Dentistry, Psychiatry & Psychology, Physiotherapy, Infertility, Diagnostic & Imaging

Additional list of New Eye Care Centres  Non-NABH
Sl.No.	Name of Hospital	Specialities empanelled for
1.	Batalia Eye Hospital Dr. Batalia Road, Near Ghantaghar, Jabalpur Tel. 4065919, 2622136	As Eye Care Centre for All Available Facilities

Additional list of New Dental Clinics  Non- NABH
Sl.No.	Name of Hospital	Specialities empanelled for
1.	Shubham Dental Clinic, Near Ashirwad Baratghar Ranjhi Jabalpur, 9329572500, 9300161600	As Dental Clinic for All Available Facilities

Source: http://msotransparent.nic.in/cghsnew/index.asp
[http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File642.pdf]

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Clarification regarding admissible non-admissible items under CGHS

Clarification regarding admissible non-admissible items under CGHS

F.No. 2-1 /2012/CGHS/VC/CGHS(P)

Government of India

Ministry of Health & Family Welfare

Department of Health & Family Welfare

Nirman Bhawan, New Delhi

Dated the 1st August, 2013.

OFFICE MEMORANDUM

Subject : Clarification regarding admissible non-admissible items under CGHS

With reference to the above mentioned subject the undersigned is directed to draw attention to the Office Memorandum of even number dated 1st October 2012 issued by this Department in compliance of the directions of Hon'ble High Court of Delhi in the case of Shri Kanhiya Singh Vs U01 and others [W.P.(C) 9044/2011] clarifying admissibility / inadmissibility of items of expenditure for claiming reimbursement under CGHS. The same are being reproduced for a wider circulation and information in compliance of Hon'ble High Court's latest direction issued on 16.05.2013 in this case. The requisite clarifications regarding admissible and non- admissible items under CGHS are provided herewith as under:-

a) "CGHS Package Rate" shall mean and include lump sum cost of inpatient treatment / day care / diagnostic procedure for which a CGHS beneficiary has been permitted by the competent authority or for treatment under emergency from the time of admission to the time of discharge including (but not limited to) — (i) Registration charges, (ii) Admission charges, (iii) Accommodation charges including patients diet, (iv) Operation charges, (v) Injection charges, (vi) Dressing charges, (vii) Doctor / consultant visit charges, (viii) ICU / ICCU charges, (ix) Monitoring charges, (x) Transfusion charges, (xi) Anesthesia charges, (xii) Operation theatre charges, (xiii) Procedural charges / surgeon's fee, (xiv) Cost of surgical disposables and all sundries used during hospitalization, (xv) Cost of medicines, (xvi) Related routine and essential investigations, (xvii) Physiotherapy charges etc. (xviii) Nursing care and charges for its services.


b) Cost of Implants / stents / grafts is reimbursable in addition to package rates as per CGHS ceiling rates for Implants / stents / grafts or as per actual, whichever is lower, in case there is no ceiling rate prescribed under CGHS,


c) During In-patient treatment of the CGHS beneficiary, the hospital will not ask the beneficiary or his / her attendant to purchase separately the medicines / sundries / equipment or accessories from outside and will provide the treatment within the package rate, fixed by the CGHS which includes the cost of all the items.



d) In cases of conservative treatment / where there is no CGHS package rate, the above mentioned items are admissible-items wise at CGHS rates or as per AIIMS rates (if there is no CGHS rate) or as per actual (if there is no CGHS / AIIMS rate) available for any item.


e) Package rates envisage up to a maximum duration of indoor treatment as follows:
12 days for Specialized (Super Specialties) treatment;
7 days for other Major Surgeries;
3 days for Laparoscopic surgeries / normal deliveries; and
1 day for day care / Minor (OPD) surgeries.

However, if the beneficiary has to stay in the hospital for his / her recovery for a period more than the period covered in package rate, in exceptional cases, supported by relevant medical records and certified as such by hospital, the additional reimbursement shall be limited to accommodation charges as per entitlement , investigations charges at approved rates, and doctors visit charges (not more than 2 visits per day per visit by specialists / consultants) and cost of medicines for additional stay).

No additional charge on account of extended period of stay shall be allowed if that extension is due to infection on the consequences of surgical procedure or due to any improper proceed.


f) In addition to the above mentioned items, some patients may require additional facilities/ procedures, which are admissible with proper justification in deserving cases. Therefore, it is not possible to give a comprehensive list of items, which are not admissible.

However, the following items are not admissible:

Telephone charges
Toiletries
Sanitary napkins
Talcum powder
Mouth fresheners

2. It has also been decided to clarify that expenses incurred on medicines, consumables, sundry equipments and accessories etc., which are purchased from outside, based on specific authorization of treating doctor / staff of the concerned hospital will be reimbursable if they are not falling under the list of non-admissible items. In case the empanelled hospital has asked a CGHS beneficiary for purchase of the said items over and above the package rates, reimbursement shall be made to the beneficiary and the amount shall be recovered from the pending bills of hospital.



3.  This Office Memorandum is issued in compliance of the directions of Hon'ble High Court of Delhi in W.P. (C) 9044/2011 [Sh. Kanhiya Singh Vs UOI and others].

sd/-

[V.P. Singh]

Deputy Secretary to Government of India

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File609.pdf

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