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183 views5 pagesCGHS Update Rules
CGHSSS
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/ 5
7
No. $.14021/38/2015-MS
Government of India
Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi-110011
Dated the2s]2/2017
OFFICE MEMORANDUM
Sub: Renewal of recognition of Ace Heart and Vascular Institute, Mohali for treatment of
Central Government employees under CS (MA) Rules, 1944.
The undersigned is directed to say that the proposal received for recognition of Ace
Heart and Vascular Institute, Mohali for treatment of Central Government Employees and their
family members under Central Services (Medical Attendance) Rules, 1944 has been examined in
this Ministry and found to be in order. It has been decided to grant recognition to the Ace Heart
and Vascular Institute, Mohali under CS (MA) Rules, 1944.
2. The Schedule of charges for the treatment of Central Government Employees and the
members of their family under the CS (MA) Rules, 1944, will be the rates fixed for CGHS,
Chandigarh. The approved rates are available on the website of CGHS
(nttp://msotransparent.nic.in/eghsnew/index.asp) and may be downloaded/printed.
3. The undersigned is further directed to clarify as under:-
(a) "Package Rate” shall mean and include lump sum cost of in-patient treatment//day
care/diagnostic procedure for which a CS(MA) 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}-() Registration charges, (ii) Admission charges, (ii)
‘Accommodation charges including patient's diet, (iv) Operation charges, (v) Injection charges,
(vi) Dressing charges, (vii) Doctor/consultant visit charges, (vill) ICU/ICCU charges, (ix)
Monitoring charges, (x) Transfusion charges, (xi) Anesthesia charges, (xii) Operation theatre
charges, (xii) 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, (xvi) Physiotherapy charges etc, (xvii) Nursing care and charges for its services.
{b) Cost of implants is reimbursable in addition to package rates as per CGHS ceiling rates
for implants.
()_ Treatment charges for new born baby are separately reimbursable in addition to
delivery charges for mother. e:
(d)__ Ace Heart and Vascular institute, Mohali shall not charge more than the package rates
fixed for CGHS Non-NABH, Chandigarh.
»
y
(e) Expenses on toiletries, cosmetics, telephone bills etc. are not reimbursable and are not
included in package rates.
Up to 12 days: for Specialized (Super Specialities) treatment '
Upto 7 days: for other Major Surgeries |
Up to 3 days: for Laparoscopic surgeries/normal Deliveries
| day: for day care/Minor (OPD) surgeries.
4 | Package rates envisage duration of indoor treatment as follows:
|
No additional charge on account of extencied period of stay shall be allowed if that extension is
ue to infection un the consequences of surgical procedure or due to any improper procedure
and is not justified,
|
In case, there are no CGHS prescribed rates for any test/procedure, then AIIMS rates are
applicable, If there are no AIIMS rates, then reimbursement is to be arfived at by calculating
admissible amount item-wise (e.g. room rent, investigations, cost of medicines, procedure
charges etc) as per approved rates/actually, in case of investigations.
5! (a) CS (MA) beneficiaries are entitled to facilities of private, semi-private or general ward
depending on their basic pay. The entitlement is as follows:-
‘SINo. | Corresponding Basic Pay drawn by the officer in | Ward Entitlement
7" CPC per month
1. | Upto Rs. 47,600/- General Ward
2. | Rs. 47,601/- to 63,100/- ‘Semi-Private Ward
3.__| Rs. 63,101/- and above Private Ward
| (b) The package rates given in rate list of CGHS are for semi-private ward,
| (c) The package rates prescribed are tor semi-private ward. If the beneficiary is entitled
for general ward there will be a decrease of 10% in the rates; for private ward entitlement
there will be an increase of 15%. However, the rates shall be same for investigation irrespective
of entitlement, whether the patient is admitted or not and the test, per-se, does not require
admission.
‘The hospital shall charge from the beneficiary as per the CGHS prescribed rates or its
3wn rate list whichever is lower. The hospital shall charge CGHS Non-NABH Chandigarh rates.
6.
4
|
i
(2) The maximum room rent admissible for different categories would be:
oe General ward Rs. 1000/- per day
Semi-private ward Rs, 2000/- per day
Private ward Rs. 3000/- per day
Day care (6 to 8 Hrs.) Rs, 500/- (same for all categories)
(b) Room rent mentioned above at (a) above is applicable only for treatment
procedures for which there is no CGHS prescribed package rate.
Room rent will include charges for occupation of bed, diet for the patient, charges for water
and electricity supply, linen charges, nursing charges and routine up keeping.
(c) During the treatment in ICCU/ICU, no separate room rent will be admissible.
(d) Private ward is defined as a hospital room where single patient is accommodated
and which has an attached toilet (lavatory and bath). The room should have furnishings like
wardrobe, dressing table, bed-side table, sofa set, etc. as well as a bed for attendant. The room
(e) Semi Private ward is defined as a hospital room where two to three patients are
‘accommodated and which has attached toilet facilities and necessary furnishings.
(f) General ward is defined as hall that accommodates four to ten patients.
{2} Normally the treatment in higher category of accommodation than the entitled
category is not permissible. However, in case of an emergency when the entitled category
accommodation is not available, admission in the immediate higher category may be allowed
till the entitled category accommodation becomes available. However, if a particular hospital
does not have the ward as per entitlement of beneficiary, then the hospital can only bill as per
entitlement of the beneficiary even though the treatment was given in higher type of ward.
If, on the request of the beneficiary, treatment is provided in a higher category of ward,
then the expenditure over and above entitlement will have to be borne by the beneficiary.
8. _In case of non-emergencies, the beneficiary shall have the option of availing specific
treatment/investigation from any of the empanelled hospitals of his/her choice (provided the
hospital is recognized for that treatment procedure/test), after the specific
treatment/investigation has been advised by Authorized Medical Attendant and on production
of valid ID card and permission letter from his/her concerned Ministry/Department,
9. The hospital shall honour permission letter issued by competent authority and provide
treatment/investigation facilities as specified in the permission letter.
ph 10. The hospital shall also provide treatment/investigation facilities to} the CGHS
beneficiaries and their eligible dependent family members at its own rates or rates approved
under CS (MA) Rules, whichever is lower. The hospital shall provide treatment to pensioner
CGHS beneficiaries after authentication through verification of valid CGHS Cards.
11. However, pensioner CGHS beneticiaries would make payment for the medical treatment
at approved rates as mentioned above and submit the medical reimbursement claim to the
‘Aid|, Director, CGHS through the CMO i/c of the CGHS Wellness Centre, where the CGHS Card
of the beneficiary is registered.
12, _ In case of emergencies, the beneficiary shall have the option of availing specific
treatment/investigation from any of the empanelled hospitals of his/her choice (provided the
hospital is recognized for that treatment procedure/test), on production of valid 1D'card, issued
by competent authority.
413, During the In-patlent treatment of the C3 (MA) beneficiary, the Hospital will not ask the
beneficiary or his attendant to purchase separately the medicines/sundries/equipment or
accessories from outside and will provide the treatment within the package rate, fixed by the
pHs: which includes the cost of all the items.
14, In case of treatment taken in emergency in any non-recognized private hospitals,
reimbursement shall be considered by competent authority at CGHS prescribed Package/rates
only.
15. If one or more minor procedures form part of a major treatment procedure, then
package charges would be permissible for major procedure and only 50% of charges for minor
procedure,
16. The Hospital shall agree for conducting all investigation/diagnostic tests/consultations
etc. of the Central Civil Services Group “A” Officers of age of 40 years and above and other
categories of CGHS/CS (MA) beneficiaries as specified by government from time to time as per
prescribed protocol as per Annexure, subject to the condition that the hospital shall not charge
tnore than Rs. 2000/- for conducting the prescribed medical examination of the male officers
and Re. 2200 for female officers of Cantral Government who come to the haspital/institution
with the requisite permission letter from their Ministry/Department/Competent authority. The
above rates for medical examination are valid until such time when the above rates are revised
by the Central Government.”
17. Any legal ibility arising out of such services shall be the sole responsibility and shall be
4ealt with by the concerned empanelled hospital. Services will be provided by the Hospital as
ber the terms given above.
18. Ministry of Health & Family Welfare reserves the right to withdraw/candel the above
ecognition without assigning any reason,
| ae 19. The order takes effect from the date of issue of the O.M. The hospital stands recognized
under CS (MA) Rules, 1944 for a period of 4 (four) years from the date of issue of this O.M.
20. The authorities of Ace Heart and Vascular Institute, Mohali will have to enter into an
agreement with the Government of India to the effect that the Hospital will charge from the
Central Government employees at the rates fixed by the Government and they will have to sign
‘a Memorandum of Understanding (MoU) within a period of 3 months from the date of issue of.
the above mentioned OM failing which the Hospital will be derecognized (Two original copies of
‘MoU printed on the stamp paper and duly signed by the Hospital to be sent for acceptance).
Subject to above, the Hospital can start treating Central Government employees covered under
CS (MA) Rules, 1944,
21. A communication in acceptance of the Para 20 above may be sent to the undersigned
within a week from the receipt of this Office Memorandum.
Bm
(Sunil Kumar Gupta)
Under Secretary to the Government of india
Tele: 23061986
Wo
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LL ae Beiter} and vascular institute, Mohali (Haryana)
3[% 2. br. Amarjit Kaur, Secretary, CWEWCC, 4" Floor, Kendriya Sadan, Sector-9A, Chandigarh,
All Ministries/Departments of Govt. of india as per etek
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