07.04.1999. Delegation of Financial Powers.pdf
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Subject:-
NO.S-12020/4/97-CGHS(P)
Governinent of India
Ministry of Health ~ Family ~elfare
(Department of Health)
Nirman Bhavan; New Delhi
Dated the 7th April, 1999.
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OFFI~E MEMORANDUM . . . ..
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Delegation of 'Powers uI1der CGHS relating to referral. system, perndssion cases and E!x-post-~acJ:'9 ~ap~~pva;t:
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-'.Regard1ng., .' I;c<;'>;~,,~?': .,' :t;\
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. .The undersigned is dLrec;ted ~b say'thatthe matter regarding
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delpg'a~i6n of'powers under CGHS has been under'c.onsideratiop..of !iIt
the Gov'ernment for some t~me past so as 'tc?reduce the <:lelay in obtaining facilities under CGHSincludingex-post-facto app~oval
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of medical claims preferred byCGHS beneficiaries:and ~t has now been decided todeleg~te' .the powers -rot"referral system, permiss.i;;on cases, J~t)ci ,ex;'post.:;,,;'fact'o approvalas.indic:ated below:-
. . :,. : ~.;'~F~1UtAL. SYST~' .' . " . .
1. Propedures/inyestigations
for which there is .no
prescr-ihed CGH$ rate .for
CGHS."r.ecognised private.
hO'spitals/diagnostic
cel1t,i'~. .
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2. .
.I;n case of medical
emergency beneficiary may
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go directly to private
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recognised! ,Government
. referral hospit.~\l.,..' .a.nd . tmbmi l: an .MRC ...r ~fter
. discharge from.' t'he
hospital.;:."
3 ~n p~egna?cy cases
permissiO~1 for.t'es t s I procedures, the. estimates of which are' not. more' than Rs.20,OOO/-, may':pegranted by HOD (for serving employees) and by Head of CGHS covered ci~ies
(for 'Pensioners) . provided the tests/ procedures ha~e been
recommended . by Govt'. Specialist.
Reimbursement may i:>edlimit.:eq
.to AIIMS rate in the caBe~()t Delhi and outside Delhi. In case rates have not been fixed by AIIMS'for any.particular
'procedure/investigation/test, reimbursement may be made- a-s per actuals. .
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P~wers are delegated to lhe Heads of the CGHS Organisations in various CGHS covered cities in respect of both pensioners and>' .serving empl()y~es. for
deciding which. case~'. :Jii11 under- the "eroergency" category. . . ~
Once .' the pregnancy is diagnosed/confirmed by' the
j Government !CGHS' doctors .' including the Medi'cal Officer
~orking at. the dispenRary
level, the HOD of ,'concer.ned Department! . Ministry..
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In case. of beneficiary,
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may permit admission for
confinement purpose in the
private. hospitals recognised under CGHS. ."f" ". The powers for grant of, such.'
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~nspite!ofifacility being availab1e: in the city' still" chooses to' get
treatment in CGHS recognised. hospi tal ill another city
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s. In case, of pensioners if permission is granted for treatmen~ in another city for such procedures/tests
that:.are' advised by thf:!. Govt'.I. CGHSC... special'ists
and are not available in the same. city
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..b.. In case of emergency in . re,;;pect of' pe'nsioner~/. ._s.~rving ~mployees','
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permission are delegated to the Heads of CGHS organisations in; various CGHS covered cities both ~n 'r~spect.of pensioners and. serving employees' but .without grant of TA/DA..
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Permis~ion mct¥ be'..granted to pensioner beneficiaries bY'Head of the CGHS 'Organisation.inthe various CGHS covered cities .on the' basis"'of. specific advice from treating .Gpvt. specialist.
. TA may be limited to' the Referral' Hospitalsavailablein the nearest city by the shortest route. In case of deviation, prior. permission of.
,Director,.CGH$, 'may be' ..obtained..
Since it is not always possible to obtain prior permission in emergency, treatment taken by CGHS beneficiaries in emergency will be considered on merits
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even if the treatment is taken
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,froma non-recognised private
hospital. For granting ex-post
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facto approval 'in emergency
.. cases,' both for s!i!rving/'
pensioner beneficiaries, the
power is deiegated to the Head
of the concerned CGHS covered
city.
7. Treatment in pri vate recognised hospital
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Referral may be made 'on the reconunendation of the tt;:'eatment procedure by the Govt.
specialist for indoor treatment in private hospitals recognised under CGHS.
The permission 'both for pensioners and" aerv.ing employees fora period of six months for follow-up treatment
may be given by the Head of CGHS covered city from the qate o'f discharge of the 'benef iciar}' from the hospital.
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PERMIsstON CASES
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1, Cases where permission is , to- be given for items with ceil~ng rates
2. Permission for items for whi6h S'tanding Committ,ees exist and the Standing Comrni t tee has recommertded 'the case
3. Supply of .Oxygen cylinder, Leucocyte filter, Infusion pump etc.
4. ,Air travel . .'
5. permission for highly expensive procedures like B .M'. T. , 'Card"iac defibrillator, carotid stents, etc. as per Govt. ceiling rates as the cost involved are very high or where there is no policy decision
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'When treatment is taken with prior permission and where the ceiling rates have been fixed for purchase of implants such as pacemakers,. Rotablatar total joint replacement etc. the procedure of calling 3 quotations i,snot required and the Head ....9f the CGHS .
organisation'of;the cqncerned CGHS ,covered c,ity may grant permission in such c~ses.
Permission may be g~ven by the Ministry' of Health and Family Welfare' for it'ems which have been notified by the CQHS.
permission maybe given by the Ministry of Health and Family Welfare on the x:eaommendations of the Standing Commi~tee for items which have:been notified
by the CGHS,
Permission may be given by the Ministry of Health 'and Family' Welfare ,on the basis of the
recommendation .of Director, CGHS.
For highly expensive procedures like BMT, Cardiac Defibrillato~, Carotid Stenting etc.M/o HFW not f fie, s t h' e equipments/instruments/ implants for domiciliary use withspecif ic ceiling 'rates. Hence, pe;mission for any instrument/equipment/implant outside the notified list will be dealt by the M/o HFW on a case t~ case basis, in consultation with DGHS/Finance Division. I
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Ex-paST-FACTO APPROVAL
1.
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'Treatment taken without recommendation of CGHS/ Govt. specialist, but \'1ith permission of CMO in-charge of CGHS dispensary in a
recognised priv~te ,hospital within approved , ceiling rates
pow~rs are delegated to the Heads of CGHS organisations in the CGHS covered cities both in respect of pensioners and serving employees to. decide such type of c'ases.
2. Treatment taken in private hospitals
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recognised under CGHS
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without prior permission
Powers are delegated t,o the 'Heads of CGHS organisations in the CGHS covered cities both in respect of pensioners and serving employees to decide
such type of cases. I
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3 . Emergency cases within approved ceiling rates in respect of treatment taken in private 'hospitals recoghised under CGHS.
4 . Emergency cases wit;hin ceiling approved rate in respect, of treatment taken i~ ~rivate
unrecogllised hospit~l. '
5. Cases where prior peD~ission for treatment in CGHS recognised Government ,referral hospital was granted for a' particular' procedure and at the time of actual 'operation, some device/artificial
'appliance/ additional treatment/ procedurel diagnostic procedure. has
been used/undertaken for which no prior permission
was taken.
6. Ex-post-facto permission for treatment in Govt. ,referral, ho.spitals, like
'AIIMS, 'PGI Chandigarh, etc. .' ,
Powers are delegated. to the Heads of CGHS organisations in the CGHS covered cities both in respect' of peI~sioners and serving employees to decide such type of cases.
Powers: are delegated to the Heads of,CGHS organisations in the CGHS coveredcities both in r~spect of pensioners and serving employees., to decide such type of cases.
Powers .are delegated to the Heads of CGHS organisations in the CGHS covered cities both in respect of pensioners and serving employees to decide such type of cases.
For servinq employees:
HOD of the concerned Ministryl Department/Office may decide such type of cases.
For pensioners:
Head of the CGHS organisation of the concerned CGHS covered city may 'decide such type of cases.Contd.../-
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7. T~eatment under emergency in private hospitals recognised under CGHS and
. approval to be given as per' approved rates for approv~d procedures/ Appliances/devices.
8. Treatment. taken tinder emergency but approval to be .given above the approvedrates .
9. ,Relaxation of CGHS Rules
10. Air travel permission/Ex post:-facto approval for air."travel undertaken for medical treatment
11. Reimbursement of :treatment/test for which . there is no prescribed rates under CGHS
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Powers are delegated to the
Heads of CGHS organisations in
the CGHS covered cities both
in respect of pensioners and
serving employees ~o decide
such type of cases. :
Ministry of Hea~th and Family
Welfare may decide 'such type
of cases in' special
circumstances,'-'depending upon
the merits of each case."
Ministry of Health and Family
Welfare will decide such type
pf cases.
Ministry of Health and Family
Welfare will decide such type
of cases.
Powers are delegated to the
Heads of CGHS organisations in
the CGHS covered cities both
in respect of pensioners and
serving employees. and
reimbursement may be made as
per AIIMS rate/actual,
.whichever may be less, or as
per actual in case there is no, AIIMS rate, both in the case
pertaining to CGHS, Delhi and
'CGHS,outside Delhi.
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Monetary limit to issue sanction for settlement of individual fy1edical Reimbursement Claims/ to accord permission/ grant of medical advance
Subject to the approval of Head of the CGHS organisation . of the concerned CGHS covered city/Ministry of Health and Family Welfare, where prescribed in the preceding paras, the monetary limit for issuing sanction has been raised as under:-
a) RS.2 lakbs
(in case
of serving
employees
beneficiaries)
b) Rs.2 lakhs
(in case
of pensioner
. CGHS.
beneficiaries) I
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By the
HOD
By the
Head of the
concerned CGHS covered city. .
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c) Rs.2 to 5 lakbs: Director,
CGHS
do) Above Rs.5r . lakhs: Ministry
,of Health
and :;
Family
Welfare,.
These orders will come into effect from the date of issue.
,3. The above orders are .issued with the approval of, S'ecretary(Health) and co.ncurrence of JS&FA vide Dy. No.1766/99-
JS&FA dated~ '23.3.99. . ~(BRAHAM DEV) UNDER SECRETARY TO 'THE GOVERNMENT OF INDIA
All Minlstries/Departments' of Government of India.
Director General. 'of Heal th Services.
Director, CGHS. '. All Additional/Deputy Directors of OGHS.
All. Officers/Sections/Desks in the Ministry of Health & Family Welfare.
C & A.G. of India, 10, Bahadur Shah Zafar Marg,
New Delhi-2, with the request that ,these 'orders may be made applicable to the persons serving under him.,,:
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7. Copy for folder.
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