Archive

Archive for the ‘CGHS’ Category

CGHS – INTERIM ARRANGEMENT FOR MUMBAI AND THIRUVANANTHAPURAM

June 27, 2010 Leave a comment
   It has been brought to the  notice of the Ministry of Health & Family Welfare that hospitals  and diagnostic centres empanelled under CGHS, Mumbai and  Thiruvananthapuram have been showing lack of interest in  continuing with CGHS due to their perceived grievance of high  amount of performance bank guarantee and the rates that were  being offered. This has resulted in the ailing CGHS  beneficiaries not being able to get treatment in private  hospitals and diagnostic centres. 
  
   The matter has been examined in  the Ministry of Health & Family Welfare and, as an interim  arrangement, it has been decided that CGHS beneficiaries in  Mumbai and Thiruvananthapuram may be allowed to get their  treatment / tests, etc., in any private hospital / diagnostic
centre in their respective cities and claim reimbursement from  their respective Departments / Ministries / CGHS, as the case may be, subject to the condition that the reimbursement would be  limited to the CGHS rates that have been fixed for the city.
 
   There will be no change in the procedure for claiming of  reimbursement of expenses. The hospitals, not being in the  list empanelled hospitals under the CGHS, may not provide  treatment under CGHS package rates for the city and may charge  their own prevailing rates. The hospitals will also not be  extending credit facilities to pensioner CGHS beneficiaries.  Hence the beneficiaries may have to spend for their treatment  from their own resources and claim reimbursement from their  respective Ministries / Departments / CGHS. Before they proceed  to get treatment in a hospital, the beneficiaries are requested  to get the permission from the concerned authorities.
Categories: CGHS

CGHS – INTERIM ARRANGEMENT FOR MUMBAI AND THIRUVANANTHAPURAM

June 27, 2010 Leave a comment
Categories: CGHS

Centre issues draft guidelines for procurement of ayurvedic medicines for CGHS

June 25, 2010 Leave a comment
Categories: CGHS, MEDICAL

Centre issues draft guidelines for procurement of ayurvedic medicines for CGHS

June 25, 2010 Leave a comment
The Central government has issued a set of draft guidelines for procurement of ayurvedic  medicines for the Central Government Health Scheme (CGHS). The  procurement shall be done through rate contract (RC) and normal  validity of RC will be for a period of two years, which may be  extended for a period of six months in one instance and upto a  period of one more year on the discretion of the ministry.
The procurement of medicines  will be recommended by a provisioning committee and shall be  approved by the ministry. A panel of medical inspection  committee shall be constituted, comprising of three members each
for two years with two months tenure will be prepared and  approval for the same will be obtained from the director CGHS to  compare the bulk supply of medicines in two phase. 
According to the draft the  ayurvedic medicines that are manufactured by Indian Medicines  Pharmaceutical Corporation Limited (IMPCL) may be procured  without inviting tender or rate enquiry at rates finalised by
the cost and account branch of Department of  Expenditure/Ministry of Finance. However this is applicable only  if IMPCL provides barcode for their list of manufacturing  medicines from next financial year.
Apart from getting ayurvedic  medicines from IMPCL, CGHS will also procure medicines from open  market through tendering process by following two bid procedure.  These medicines would be generic medicines that are not in the  list of medicines being produced by IMPCL or medicines which are  certified by the IMPCL having not produced for the period and  proprietary medicines as per approved CGHS formulary under
disease category.
The draft mentions that the  procurement of the medicines shall also be done through approved local chemists if a formulary medicine is not available in the  store dispensaries, units or hospitals and even the medicines of
equal therapeutic value is is not available in the existing  formulary.
It has been notified that the  medicines shall be procured only from the firm that has a  manufacturing unit with an average annual turnover of rupees 50 lakh per year for three years. Interested firm should be able to
pay Rs 25,000 and performance security of Rs 50,000 EMD for a  period of four to five months and performance security for a  period of three years. 
The firm should possess for the last  three years the Good Manufacturing Practice (GMP) certificate  issued under Schedule T of the Drugs and Cosmetics Act 1940  rules there under in force. The draft specifies that all the  firms catering should be able to provide barcode system for the  selected medicines on the label and packaging unit. “Procurement of ayurvedic  medicines for CGHS, Delhi will be made as per annual  provisioning worked out on the pattern of daily patients  attendance rate (DPAR) formula and annual demand submitted by  the hospitals.
The provisioning of classical and patent  proprietary medicines of IMPCL and other firms will be made on
the assumption of the last three years,” the draft states. It states that the first  preference for the procurement of the medicines shall go to  IMPCL. However the draft clarifies that CGHS may procure  medicines which are not supplied by the IMPCL from state  government or co-operative pharmacies provided they are willing  to supply medicines on CGHS rate contract. It states that the  ratio of 60:40 in terms of value in classical and propriety  medicines will be maintained in the CGHS procurement.


Categories: CGHS, MEDICAL

Follow-up Treatment of CGHS Beneficiaries in Recognized Hospitals

June 23, 2010 Leave a comment
#fullpost{display:inline;}

The undersigned is directed to refer office memodum No. S.11017/1/95-CGHS (P), dated September 20, 1995 and to say that it has been decided to modify the order in view of difficulties being faced by Central Government Health Scheme beneficiaries.

It has now been decided that the CGHS beneficiaries will be  eligible for follow-up treatment relating to Neuro Surgery, Cardiac  Surgery (including Coronary Angioplasty & implants), Cancer  Surgery/Chemotherapy/Radiotherapy, Kidney transplantation, Hip/Knee
replacement Surgery and Accident cases in the same  Institutions/Hospitals where the treatment was earlier carried out
with prior permission of competent authority. The follow-up treatment will however, be subject to the following conditions :

  1. The reimbursement of expenditure for Consultation/Treatment
    including hospitalization
    if required/Investigations will be
    limited to rates as fixed
    under Central Government Health Scheme.

     

  2. The beneficiary should collect all the OPD medicines
    prescribed in connection with the treatment from the dispensary
    concerned in normal timing. In emergency
    these could be procured
    from market.
  3. In case there is no approved CGHS rates for any procedure, or test,
    reimbursement will be made as per All India Institute of Medical
    Sciences rates, if any, or actual whichever is less or as per actual in
    case there is no AIIMS rates also.
  4. Reimbursement in respect of Central Government Employees and other
    working employees and pensioners of autonomous bodies which were covered
    under CGHS will be made by respective departments from Service Head;
    from Rajya Sabha/Lok Sabha Secretariat as the case may be in case of
    Member of Parliament and EX-Member of Parliament. In respect of Central
    Government Pensioners, Freedom fighters etc. covered under Central
    Government Health Scheme, the reimbursement will be made by respective
    Additional/Joint/Deputy Director of CGHS of concerned City from CGHS
    head.
  5. Permission for follow-up treatment may be granted by the Head of the
    Department in case of Central Government Employees, working employees
    and pensioners of Autonomous Bodies admitted under the scheme and by
    Rajya Sabha Secretariat/Lok Sabha Secretariat as the case may be in case
    of Members of Parliament and Ex-MPs and by CMO Incharge of concerned
    CGHS Dispensary in case of Pensioners, Freedom Fighters etc. for 3-6
    months at a time, which may be extended if required on the bases of
    medical record.
  6. In case of other conditions 9other than those mentioned earlier)
    where prior permission for treatment in a private hospital recognized
    under CGHS is granted, regular follow-up treatment is to be obtained
    from CGHS Dispensary/CGHS/Govt. specialist only. However the OPD
    medicines prescribed on discharge summary may be issued by concerned
    CGHS dispensary up to a maximum period of one month.
  7. Permission for follow-up treatment in case of accidents, where
    patients were admitted under emergency without prior permission in
    recognized hospitals under CGHS may be considered by Head of CGHS
    Organization of city concerned subject to Ex-post facto sanction for
    initial treatment based on discharge summary and possession of a valid
    CGHS card. In such cases Medical reimbursement claim may be accompanied
    by a copy of the Permission letter.
  8. In exceptional cases where permission for treatment of the above
    mentioned conditions in a private un-recognized hospital was granted by
    Ministry of Health and Family Welfare, permission for follow-up
    treatment may be considered by Head of CGHS organization of concerned
    city on a case to case basis and HOD in respective cities.
  9. This issues with the concurrence of Finance Division vide Dy. No.
    2266/JS (FA) dated 4/4/2001.
Categories: CGHS

Follow-up Treatment of CGHS Beneficiaries in Recognized Hospitals

June 23, 2010 Leave a comment
Categories: CGHS

Procedure for Referral to Recognized hospitals Simplified.–CGHS

June 23, 2010 Leave a comment
#fullpost{display:inline;}
   In supersession of this Ministry’s Office Memorandum of even number, dated 21/6/1996 on the above subject and keeping in view the inconvenience being faced by the CGHS beneficiaries, it has been decided that :

1. The beneficiaries will have to option of availing specialized treatment at CGHS recognized hospital of his/her choice after a specialist of CGHS/Government hospital recommends for the same. A certificate regarding non-availibility of beds in Government hospital would not be required. The terms “Government hospital” would include any hospital of a State Government/Government Departments such as Railway, Atomic Energy Commission etc., as also hospitals of Public Sector Undertakings (such as those of the Steel Authority of India Limited/Coal India Limited, etc.)

2. In non-emergency cases, once the recommendation (regarding line of treatment) of a CGHS specialist or a specialist of a hospital of Central/State Government/a Public Sector Undertaking has been obtained, the procedure for obtaining Administrative approval would be as follows:-

In case of serving Government servants, after the Specialist advises a procedure in writing, the permission letter for taking such treatment in a CGHS recognized private hospital/referral hospital of choice in the same city, would be given by the parent Department/Office of the employee.

In case of Pensioners, (including Ex-MPs, Former Governors, etc.), after the initial advice of a specialist has been obtained, the permission letter for such treatment would be given by the CMO Incharge of the concerned CGHS dispensary, but the bill would be raised in the name of Additional Director, CGHS concerned, as in the case of pensioners, the payment is to be made by
CGHS directorate.

In case of a medical emergency, the details of which shall be recorded in writing by the CMO Incharge of the CGHS dispensary, the CMO concerned by directly (i.e., even before specialist’s advice has been obtained) refer the CGHS beneficiary to a private recognized hospital for further management / treatment.

The expenditure to be reimbursed by the parent department/office/CGHS Directorate, as the case may be, would be restricted to the package deal rates/rates approved by the Government from time to time. The expenditure in excess of the approved rates/package deal would have to be borne by the beneficiary himself/herself.

In case the beneficiary, in spite of the facility being available in the city still chooses to get treatment in CGHS recognized institutions in another city, permission may be given, but in such cases T.A/D.A would have to be borne by the beneficiary himself/herself.

For availing treatment outside the city of residence of a beneficiary, the permission of Director/Additional Director/Joint Director of the city have to be obtained.

2. These orders will be applicable from the date of issue.

3. This issues with the approval of Joint Secretary & FA vide his Dy. No.
3110 dated 10/6/1997.

Categories: CGHS

Procedure for Referral to Recognized hospitals Simplified.–CGHS

June 23, 2010 Leave a comment
Categories: CGHS

Revised Ceiling for Reimbursement of Expenses on Purchase/Replacement of Hearing Aid

June 23, 2010 Leave a comment

   The undersigned is directed to say that a Committee was appointed to consider the issue of revision of rates of Hearing Aids fixed by this Ministry vide O.M. No. S-14025/36/93-MS dated 26/9/1994 and also to determine a time period for replacement of the hearing Aids. On the recommendations of the Committee of experts, it has been decided to fix the maximum ceiling rate up to Rs. 10,000 for body worn/pocket/behind  the ear type/in the canal type (conventional), as per requirement of the patient for one-sided Hearing Aid.

    Any patient requiring a bilateral Hearing Aid on the basis of his/her hearing loss and its attendant disability/speech training requirement/rehabilitation, specially in child/job requirement in adult may be permitted up to a maximum ceiling of Rs. 20,000/-. However, the hearing Aid should be recommended by ENT surgeon after considering the  hearing loss of a patient and its attendant disability supported by  audiometric evidence.

 
2. In special circumstances, digital Hearing Aid may also be  reimbursed up to a limit of Rs. 60,000/- on the recommendation of  three ENT experts

 

3. Keeping in view the average life of Hearing Aid as five years, a  replacement may be permitted on the basis of a condemnation  certificate from a technical expert and on approval of ENT  Specialist.

   
4. These orders will be applicable to both types of beneficiaries viz., CGHS beneficiaries and the beneficiaries covered under CS (MA) Rules.

 5. The orders will come into effect from the date of issue.

6. This issues with the concurrence of Finance Division vide their Dy. No. 3653/99 JS & FA (H) dated 23/7/1999.

Categories: CGHS

Revised Ceiling for Reimbursement of Expenses on Purchase/Replacement of Hearing Aid

June 23, 2010 Leave a comment
Categories: CGHS