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

Renewal of CGHS Plastic Cards – reg.

S 11011/1/2014-CGHS (P) 

Government of India 

Ministry of Health and Family Welfare 

Department of Health and Family Welfare 

CGHS (Policy) Division

Nirman Bhavan, New Delhi 

Dated: the 10th February, 2014

OFFICE MEMORANDUM

Sub: Renewal of CGHS Plastic Cards – reg.

The undersigned is directed to refer to this Ministry’s O.M No.S.11012/3/2011-CGHS (P) dated 29.12.2011 laying down the guidelines for issue of individual plastic cards to CGHS beneficiaries. CGHS Plastic Cards were introduced in September, 2008 in Delhi NCR and the cards were initially issued with a validity period of 5 years. The CGHS Plastic Cards completing their validity period are due for renewal and accordingly fresh cards with renewed validity period are being issued by the Office of Additional Director, CGHS of the city concerned. With a view to further streamline the process of renewal of CGHS Plastic Cards, it has been decided to issue the following guidelines supplementing the existing instructions on issue of CGHS Plastic Cards:

Serving beneficiary

a) Application for renewal of CGHS Plastic Cards in the prescribed proforma (Form AA) alongwith requisite documents (current photographs, copy of pay slip and address proof of residence, if changed), should be submitted through their Administrative Office to the Office of Additional Director, CGHS of the respective CGHS city following the same procedure as prescribed for issue of fresh CGHS card.

b) Fresh CGHS Plastic Cards with same beneficiary ID nos. shall be issued with a validity period of 5 years.

c) Applications for renewal of old plastic cards can be made 3 months in advance prior to its expiry.

Pensioner beneficiary

a) Application for renewal of Pensioners’ CGHS Plastic Cards in the prescribed proforma (Form BB) alongwith requisite documents (current photographs, PPO or LPC, address proof, if changed) should be submitted to the parent CGHS Wefiness Centre where his /her card is registered. He / she can also submit the application to the Office of Additional Director, CGHS of the respective CGHS city for renewal of CGHS cards.

b) Fresh CGHS Plastic Cards with same beneficiary ID nos. shall be issued with validity for lifetime or up to the date for which the contribution has been made by the beneficiary.

c) Applications for renewal of old plastic cards can be made 3 months in advance prior to its expiry. This issues with the approval of Additional Secretary and Director General, CGHS.

End: Specimen Form AA and Form BB.

Sd/- 

(V.P.Singh) 

Deputy Secretary to the Government of India

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File666.pdf

Treatment from CGHS Empanelled Hospitals

Government empanels private hospitals under CGHS for indoor treatment and treatment can be undertaken with prior permission or under emergency. OPD medicines are issued by CGHS Wellness Centres on the prescription by CGHS Medical officers / Government specialists only.

In case of cardiac surgery, cancer treatment, neuro-surgery, renal transplantation and hip/knee joint replacement surgery, there is provision for issue of permission for post-operative follow up treatment from the same empanelled hospitals, where the initial treatment was taken with prior permission. In such cases OPD medicines as per the available brand name / generic name are issued by CGHS Wellness Centres.

In respect of other post-operative cases, where permission was granted, there is provision for issue of OPD medicines on the prescriptions of empanelled hospital for up to one month.

This was stated by Shri GhulamNabi Azad, Union Minister for Health and Family Welfare in a written reply to the Lok Sabha today.

Source: PIB

Cashless Facility TO CGHS Beneficiaries

Central Government Health Scheme (CGHS) empanels private hospitals for providing inpatient medical treatment to its beneficiaries. They may avail the requisite treatment with prior permission for procedures advised by CGHS and other government specialists / CMO–in-charge. CGHS pensioner beneficiaries are entitled for cashless medical treatment in the CGHS empanelled private hospitals. The empanelled private hospitals under CGHS provide treatment to the pensioners on credit /cashless basis for the procedures for which they are empanelled.

However, in case of emergency conditions empanelled hospitals are expected to provide treatment to pensioners on credit basis, even for conditions for which they are not empanelled and they are expected to shift the patient to another empanelled hospital after stabilization as per the Memorandum of Agreement (MoA) signed with government.

In case of violation of the terms of the Memorandum of Agreement, suitable action, including depanelment can be initiated against errant hospitals.

This was stated by Shri Ghulam Nabi Azad, Union Minister for Health and Family Welfare in a written reply to the Lok Sabha today.

Source: PIB

Extension of CGHS facility to State Govt Employees..?

While answering to a question in Parliament, Minister Shri.Ghulam Nabi Azad said that the Central Government Health Scheme is primarily meant for the Central Government employees and pensioners receiving salary / pension from Central Civil Estimates of Government of India. 

The State Government employees and other members of public are not eligible to join CGHS. However, no requests from State Governments including Kerala have been received for improvement in CGHS. 

CGHS is basically providing the dispensary services through its Wellness Centres manned by the General Duty Medical Officers. However, CGHS also provides the services of medical specialists through the Polyclinics and Central Government hospitals. In addition, the CGHS medical specialists also visit designated dispensaries on stipulated days in each week to provide medical consultation to the beneficiaries. Due to shortage of specialists in CGHS it is practically not feasible and financially viable to provide Specialist facilities in each CGHS Wellness Centre. Moreover, CGHS is also engaging contractual specialists against the vacant posts of specialists to provide the medical consultation services to its beneficiaries. 

CGHS has a dedicated wing of specialists at the Safdarjung Hospital, New Delhi for its beneficiaries. The CGHS beneficiaries are also allowed to consult specialists at Dr. RML Hospital and other Government hospitals in NCR in respective specialties. In addition, CGHS has empanelled a large number of private hospitals to provide inpatient medical care to its beneficiaries on the advice of Government specialists. 

As per the Terms & Conditions for empanelment under CGHS, all empanelled private hospitals are required to provide credit facilities to the CGHS beneficiaries in case of emergency. Pensioners and other specified category of beneficiaries are entitled for credit facilities under normal circumstances also. Non-compliance of the said provision attracts penalty as per the Memorandum of Agreement signed by them. 

Grant of fixed medical allowance to Defence civilians who residing in area not covered under CGHS.

OFFICE OF THE PR. CONTROLLER OF DEFENCE ACCOUNTS (PENSIONS)

DRAUPADI GHAT, ALLAHABAD- 211014

Circular No. 117

Dated: 16 /01/2014

Subject: Grant of fixed medical allowance to Defence civilians who residing in area not covered under CGHS.

Reference: This office circular No. 03 dated 30-03-1999.

Please refer to this office circular No. 03 dated 30.03.1999 under which Min. of PPG & P, Deptt of P & PW OM No. 45/57/97-P & PW (C) letters dated 24.08.1998 and 30.12.1998 were circulated for implementation of Govt. decision. As per P & PW OM dated 30.12.1998, pensioners who adopted Fixed Medical Allowance or medical facilities under CGHS or corresponding health scheme in accordance to P & PW OM No. 45/57/97-P & PW (C) dated 19.12.1997 circulated under this office circular no. G1/C/195/Vol-I/Tech dated 25.02.1998, can change their option once in the life time. As per existing procedure for change in option, pensioners submit their option to their PDA and PDAs take action accordingly.

In this context, it has been decided that pensioners who had originally opted for medical facilities under CGHS or corresponding health scheme may desire to change their option to draw Fixed Medical Allowance, in such cases Fixed Medical Allowance will be authorized by this office from the date of option, through Corr. PPO.

For issue of Corr. PPO, pensioners are required to submit their application with revised option (Specimen enclosed as annexure-A) to this office, duly supported with a certificate from PDA to the effect that above named pensioner has not opted for Fixed Medical Allowance (specimen of the certificate enclosed as Annexure-B).

In cases where pensioners have originally opted for Fixed Medical Allowance and now want to avail medical facilities, they will submit their revised option to their PDA and after receipt of revised option PDA will stop the payment of Fixed Medical Allowance from the following month of the receipt of the revised option and issue a certificate for stoppage of Fixed Medical Allowance.

Sd/-

 (S B Mathdevaru)

DyCDA (P)

Source:http://pcdapension.nic.in/6cpc/Circular-117.pdf

CGHS Hospitals will stop cashless treatment from 1st Febraury

The 800 hospitals in the country empanelled under the Central Government Health Scheme will stop cashless transactions from February 1, 2014, because, they claim, the government has not cleared arrears of Rs 600 crore.

The aggrieved hospitals have come together under the umbrella of the Association of Healthcare Providers India and had served notice to the CGHS office in New Delhi on December 13, 2013.

A meeting with the Union health secretary K.N. Desiraju on January 9 yielded no results.

A senior officer of AHPI said, “The amount has been budgeted in the health budget and it must be released. But it is not being done. Hence, the question is, where is it going?”

Since 2010, the hospitals have been complaining of 40 per cent unauthorised deductions in the payments. Now they have come together to put across their point to the government.

AHPI general secretary for AP Govind Hari says, “The problem started in 2002 when they started inviting tenders. In doing so, they reduced the cost of surgeries drastically. Also, orthopaedic treatment costs Rs 3,200 in Karnataka and Rs 10,000 in AP. These errors in terms of determining the cost put the hospitals in a spot.”

A senior member of the APHI said, “We want to quit as it has become more of a burden than a service as the clearance promise of 180 days is hardly followed.”

Additional director, CGHS, Dr Prasad, says, “We have not received any communication from the hospitals.” But senior officers in the Begumpet office of the department say there has been an assessment of the pending amount, and deliberations have started to sort out that matter.

Source : Deccan Chronicle

Govt to revise rates for CGHS empanelled hospitals

In a good news for lakhs of beneficiaries under the Central Government Health Scheme (CGHS), the Government is in the process of revising the rates of medical procedures offered by empanelled hospitals and diagnostic centres and giving them early payment assurance to encourage more medical institutions join the scheme.

The Ministry of Health and Family Welfare has floated e-tenders for empanelment of hospitals and decided that the rates of various medical procedures would be fixed by an average of rates quoted in e-tenders instead of the old system where the lowest quotation became the rate.

Rates of all medical procedure centres under CGHS would be revised by April next year.

Details of Dental Clinics in New Delhi under Central Government Health Scheme

Press Information Bureau 
Government of India 
Ministry of Health and Family Welfare

17-December-2013 18:46 IST 
Details of Dental Clinics in CGHS Dispensaries 
Central Zone : New Delhi

S.No.	Wellness Centers	Address
1	Dr. Z.H. Road (D44)	CGHS Building, Dr. Z.H. Road, New Delhi.
2	Chitra Gupta Road (D51)	CGHS Building, Near Aram Bagh, New Delhi.
3	Aliganj, Lodi Road .I (D9)	CGHS Building, Near LodhiRoad, New Delhi.
4	Kali Bari (D 76)	CGHS Building, Kali Bari Marg, DIZ Area, New Delhi.
5	CGHS DispensaryChanakyapuri	CGHS Dispensary Chanakyapuri, New Delhi.

   The dental services in CGHS Delhi have been outsourced in 13 Wellness Centres (5 under Central Zone and 8 under South Zone) for 22 dental procedures. The location wise details are as follows: 

Criteria for Setting up of CGHS Dispensary

Press Information Bureau
Government of India

Criteria for Setting up of CGHS Dispensary

   The criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary in a particular area are 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 2,000 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.

Administrative Functioning of CGHS Unani

        Central Government Health Scheme provides the healthcare facilities to its beneficiaries predominantly in the Allopathic system of medicine as per their demand. AYUSH system of medicine is a very small component under CGHS. The Unani system is an even smaller component of AYUSH. There are 10 small units of Unani system consisting of one or two Unani doctors and pharmacists attached to main CGHS Wellness Centres in Delhi, Kolkata, Lucknow, Hyderabad and Bangalore.

Private Hospitals threaten to stop CGHS treatment

   Cashless treatment may be stopped for central government employees
 
   Corporate hospitals across the country have threatened to stop cashless treatment to lakhs of Central Government employees from January 1. This will impact about 45 lakh employees of the Central Government and public sector agencies who are benefiting from the insurance scheme.

   Protesting against “unviable” rates being given to them under the Central Government Health Scheme (CGHS), the Association of Healthcare Providers (India) (AHPI) has said that it will give three months’ time to the Government to revise the rates.

Computerization in Central Government Health Scheme (CGHS).

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA
UNSTARRED  QUESTION NO 1691
ANSWERED ON   16.08.2013
COMPUTERIZATION IN CGHS

1691 . Shri RAJAGOPAL LAGADAPATI

Will the Minister of HEALTH AND FAMILY WELFARE  be pleased to state:-

(a) whether all the allopathy and AYUSH dispensaries/hospitals under Central Government Health Scheme (CGHS) in the country have been Computerized

(b) if so, the details thereof and if not, the reasons therefor, dispensary/hospital wise;

(c) the time by which the remaining dispensaries/hospitals are likely to be computerized;

(d) whether the beneficiaries can avail the facilities of CGHS from anywhere in the country;

(e) if so, the details thereof and if not, the reasons therefor; and