OM for HCOs.pdf
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Subject: lnstructions to Empanelled Health Care Organisations (HCOs) for providing timely and proper healthcare services to CGHS beneficiaries
A11 empanelled Health Care Organisations (HCOs) under CGHS are directed to ensure strict compliance with the following instructions for proper and timely delivery of healthcare services to CGHS beneficiaries:
1. Compliance with CGHS provisions: All HCOs shall strictly follow the CGHS MoA, applicable guidelines, packdge rates and instructions issued by the competent authority
from time to time.
2. No discrimination: CGHS beneficiaries shall not be discrimilated against in
consultation, investigation, admission, treatment or any other covered service. 3. Availability of services: A11 treatments, investigations and facilities available at the HCO, including outsourced services, shall be provided to CGHS beneficiaries as per applicable CGHS provisions and rates.
4. Emergency treatment: Emergency cases shall be attended to immediately. Treatment shall not be denied or delayed on account of procedural formalities not applicable in an
emergency.
5. No inadmissible charges: No advance, security deposit, registration fee, file charge, documentation charge or other inadmissible amount shall be collected from CGHS beneficiaries for covered services.
6. CGHS card: HCOs shall not insist on aphysical CGHS card or photocopy of the card. 7. Medicines and consumables: Medicines, surgical items and consumables covered under the approved package shall be provided by the HCO. Beneficiaries shall not be
directed to purchase such items from outside.
8. Package rates: Approved CGHS package rates shall be strictly followed. Items and services included in a package shall not be billed separately.
9. Bills and claims: Bills and claims shall be accurate, complete, supported by relevant records and submitted through the prescribed system within the stipulated time.
10. Feedback and geo-tagged photograph: HCos shall obtain feedback form and upload the feedback form and mandatory on the NHA portal.
the beneficiary's signed geo-tagged photographs
11. CGHS help desk: HCOs shall maintain a properly staffed CGHS desk and designate responsible personnel. Staff dealing with CGHS beneficiaries shall be adequately trained in applicable CGHS procedures.
12' Discharge documents: Discharge summaries, investigation reports, diagnostic images and other documents required under CGHS provisions shall be provided to the beneficiary without any inadmissible charge.
13' Timely discharge: A beneficiary deciared medically fit for discharge shall be discharged without avoidable delay. Administrative formalities shall not be used to unnecessarily withhold discharge.
14' Discharge medicines: Discharge medicines shall be provided strictly as per applicable CGHS provisions and prescribed limits. Inadmissible items shall not be included in CGHS claims.
15. Accreditation and eligibility: HCOs shall continuously maintain all applicable eligibility and accreditation requirements and promptly inform CGHS of any change in their status.
16. Non-Admissible ltems: The charges for items and services that are covered under the In-Patient package shall not be billed separately to CGHS beneficiaries. The following are illustrative and not exhaustive: Special beds, DVT prophylaxis, Syringe infusion pumps, Monitors, ECG leads, Portable equipment, RT feeding, Enema, Duty Doctor, Dietician, Barber, Toiletriep, Sanitary wipes, Moisturisers, Bedpans, and Uro-bags.
17' Inspection and audit: HCOs shall extend fulI cooperation during inspections, audits and verification of records by CGHS or authorised agencies.
18' Accountability for non-compliance: Any violation of CGHS provisions, approved rates or empanelment conditions shall be dealt with as per appiicable rules, including recovery, penalty, suspension, forfeiture of PBG andlor de-empanelment, wherever applicable.
All empanelled HCOs are hereby directed to ensure strict compliance with the above instructions. Any non-compliance shall be viewed seriously and dealt with in accordance with the terms and conditions of empanelment and applicable CGHS provisions.
. *,;pr,
Dr. Sanjeev -DT. Kendre,
Additional Director,
Copy to:
t. All empanelled Health Care Organisations under CGHS. 2. All concerned CGHS Wellness Centres/Offices. 3, Office Order File.
CGHS Pune.
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Additional Director *. q. wr.d.,gd C.G.H.S., PunE
