instructions to hospitals.pdf
Government of India
Ministry of Health & Family Welfare Office of the Additional Director Central Government Health Scheme
6, Esplanade East (Gr. Floor), Kolkata - 69
ROUS
NASCIT
Your Health, Our Goal
LIGA TINTE, KUR USU
File No: 112-28/CGHS/Kol/VL/2016/XV/ 914!
भारत सरकार
स्वास्थ्य एवं परिवार कल्याण मंत्रालय
अपर निदेशक का कार्यालय केन्द्रीय सरकार स्वास्थ्ययोजना
6, एस्पलानेड, पूर्व, कोलकत्ता
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700069
Date: 01/11/2024
NOTIFICATION
Subject:
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Reiteration of the guidelines issued by Ministry of Health & Family Welfare, CGHS and
Dte General of Health Services
With reference to the above mentioned subject, the undersigned is directed to draw attention to the terms and conditions of empanelment under CGHS and to reiterate that the Hospitals / Diagnostic / Imaging, Eye and Dental centres empanelled under CGHS shall provide better services to the CGHS beneficiaries and the following instructions are to be followed strictly by all HCOs empanelled under CGHS Kolkata, failing which necessary action will be initiated in accordance with the MoA.
1. Cashless CGHS facility is obligatory for Pensioners, Ex-Members of Parliament (Ex MP), Sitting
Members of Parliament (Sitting MP), Freedom Fighters, Serving CGHS/DGHS / Ministry of Health & Family Welfare employees and there is no provision to take advance Deposit / Payment at the time of admission.
2. Beneficiaries are not to be charged separately for infection control. It is essential for the HCOs to maintain infection control. Charges like admission fees, MRD charges, service-charges are not to be billed separately while providing services to the CGHS beneficiaries.
3. Do not demand a photocopy of the CGHS card from the CGHS beneficiaries.
4. Hospitalized beneficiaries and those beneficiaries admitted on emergency basis do not require
any separate permission letter.
5. The stamp is not mandatory on the referral memo for providing services to the CGHS beneficiaries.
6. Prescription must be given in a printed form always.
7. Prescriptions should strictly adhere to the Government's policy by being in a generic format.
8. Dietary supplements / Cosmetic items should not be included in the prescription.
9. Establish a dedicated CGHS Kiosk (Helpdesk) to provide hassle free services to CGHS
beneficiaries.
10. Ensure that the name of the Nodal Officer and contact number are prominently displayed. Any
change to the Nodal Officer must be immediately communicated to this Office.
11. The HCO shall retain a scanned copy of the print out of the referral and return the original permission letter to the beneficiary.
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12. Bills to be verified and signed by the CGHS Pensioners beneficiaries at the time of discharge. The same shall be uploaded on NHA Portal.
13. Double billing for services to the CGHS beneficiaries on the part of the HCOS are strictly prohibited.
14. The CGHS cards are valid for treatment all over India and hence CGHS beneficiaries from
other cities are eligible to avail treatment at any empanelled CGHS HCO at CGHS admissible rates and those eligible for credit benefits shall be given the same.
15. Retired Air India employees with valid CGHS card are eligible for cashless treatment at all CGHS empanelled Health Care Organization (HCOs) and their bills are to be processed through UTI-ITSL portal.
16. CS (MA) beneficiaries and their dependent family members can get treatment at CGHS rates from any of the CGHS empanelled HCO,
17. Emergency cases:
The HCO shall not insists for referral or endorsement from CGHS authority and shall provide cashless treatment to the eligible CGHS beneficiaries and based on the emergency certificate given by the treating CGHS empanelled Hospital specialist.
The claim shall be uploaded to BCA (presently TMS at NHA portal) along with Emergency certificate issued by the treating specialist.
The referral or endorsement is not required for emergency unlisted investigations /
treatment also.
For emergency unlisted procedure/ investigation the hospital shall raise the enhancement or approval through NHA portal and there is no need for approval from local CGHS AD
office.
18. Provisions for CGHS beneficiaries below 70 years:
The guidelines issued by OM dated 28.06.2024 stated at point B (ii) for CGHS pensioners below the age of 70 years are mentioned as below:
The Investigations/Minor treatment procedures not requiring admission advised by specialist of CGHS empanelled hospital after initial referral by CGHS Medial Officers are applicable to Hospitals, Dental and Eye Care Centres only and not applicable for CGHS empanelled Diagnostic/Imaging Centres. Investigation costing less than Rs 3,000/- each (NABH / NABL rate) can be performed without further referral except for CT Scan, MRI, PET CT Scan which irrespective of the rate will require endorsement from the CGHS Medical Officer. No referral from CGHS Medical Officer is required for minor procedure not requiring admission and the hospital can claim at the NHA portal with proper justification.
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Further clarification regarding the above mentioned provisions are given as below:
The above mentioned investigation/ minor procedure not requiring admission and follow-up consultations after initial referral from CGHS Medical officers are applicable without further referral when done only at the same empanelled hospital where primary consultation is done within the validity of 3 months from the date of issue of the initial referral and this is not valid
in another HCO.
In case CGHS beneficiary wants to get the investigations/ minor procedures not requiring admissions done in any other hospital, prescribed by the Specialist of Pvt. Empanelled HCOs, that need to be endorsed by the CGHS Medical Officer.
In case CGHS beneficiary wants to get the advised investigations done in any empanelled Diagnostic / Imaging Centres, that must be endorsed by the CGHS Medical Officer. Referral/endorsement would be required from CGHS Medical Officers for any procedure advised by CGHS empanelled hospital specialist which require admission and would be valid
for 3 months.
19. Special Provisions for CGHS beneficiaries above 70 years:
CGHS beneficiaries aged 70 years and above shall be permitted to seek OPD Consultation from Specialists of hospitals empanelled under CGHS without referral from CGHS Wellness Centre. The Terms & Conditions remains same, mentioned in OM dated 29.05.2019 and 28.06.2024. Any listed investigations and procedures regardless of the costs or whether admission is required can be performed on the basis of the advice by the empanelled HCO / Government Hospital Specialist without further referral from CGHS Wellness Center and can be undertaken
at any CGHS empanelled HCO.
However approval from CGHS authorities is required for planned unlisted procedures / investigations.
20. Undertaking by the CGHS beneficiaries:
• CGHS beneficiaries 70 years and above seeking services directly at any empanelled HCO, need to
submit the Undertaking in the format circulated from the Directorate (Annexure A) at the
HCO. This undertaking needs to be mandatorily uploaded by the HCO as a document during submission of claim at NHA portal.
Undertaking is also required for beneficiaries below 70 years in the format circulated by the
Directorate (Annexure A) for follow up consultation / follow up investigation / minor
procedure not requiring admission without CGHS referral at the same empanelled hospital
where primary consultation was done.
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21. Planned unlisted investigations/procedures:
Permissions for planned unlisted investigations/procedures advised by Empanelled Hospital / Government Specialists shall be given as per the delegation of financial rules:
(1) Additional Director / Director in case of pensioners
(II) HOD/HOO in case of serving employees
In case of any complaint regarding excess billing/advance payment / harassment of CGHS beneficiaries is received in this Office, necessary action will be initiated against the HCO as per the MoA.
To
All HCOs empanelled under CGHS Kolkata.
Copy to:
1.
PS to Director, CGHS, CGHS Bhawan, Sector-13, R.K.Puram, New Delhi 2. ADDG (HQ), CGHS, CGHS Bhawan, Sector-13, R.K.Puram, New Delhi
3. The All CMO I/Cs of CGHS W.C, Kolkata.
4. The CMO(RH-I), CMO( RH-II), CMO(RH-III), CGHS Kolkata
5. The Sanctioning Authority, CGHS Kolkata
6. The DDO, CGHS Kolkata
7. The In-charge of Polyclinic and MSD, CGHS Kolkata
8. The Guard File.
M2224
(Dr. Keshab Mandal)
Additional Director
CGHS Kolkata
अपर निदेशक
Additional Director सी.जी. एच. एस. / C.G.H.S.
/Kolkata-700 069
6, एसप्लानेड पूर्व / 6, Esplanade East
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