No: S. 11011/23/2009-CGHS D. II/Hospital Cell
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
* * * * *** * ** ** *
Maulana Azad Road, Nirman Bhawan
New Delhi 110 108 dated the 15th July 2011.
OFFICE MEMORANDUM
The undersigned is directed to state that CGHS had initiated action for fresh empanelment of private Diagnostic Laboratories / Imaging Centres under CGHS, Bengaluru, Chennai and Mumbai and also for the revision of package rates (which were fixed in 2007), to be paid to diagnostic centres, by floating tender for the same. On the basis of the responses received rates for various procedures / treatments have been arrived at and have been uploaded in the website of CGHS: www.mohfw.nic.in/cghsnew\index.asp and can be downloaded.
2. The undersigned is directed to enclose a list of Diagnostic Laboratories and Imaging Centres that have conveyed their acceptance of the CGHS rates announced for different cities and have signed the Memorandum of Agreement with CGHS and have also furnished the appropriate performance bank guarantee. These Diagnostic Laboratories and Imaging Centres are now taken as included in the list of approved list for empanelment under CGHS, Bengaluru, Chennai and Mumbai. However, empanelment of Imaging centres is provisional subject to recommendation for empanel merit by QCI after inspection.
3. In order that CGHS beneficiaries get treatment from well maintained and run diagnostic centres, it has been decided to have differential rates of reimbursements, as per details given in the enclosed rates list. The principle followed for the differential package rates being:
(i) where L-1 rates were arrived at on the basis of rates quoted by non-NABL accredited diagnostic centre, NABL accredited diagnostic centres will be entitled to reimbursement of certain percentage of additional amount over and above the L-1 rates; and
(ii) where L- I rates were arrived at on the basis of rates quoted by NABL accredited diagnostic centres, then non-NABL accredited diagnostic centres would be entitled to an amount lower by certain percentage than the reimbursement made to NABL accredited diagnostic centres at L-1 rates.
(iii) NABL accreditation is not required for Imaging Centres and therefore, rates prescribed for NABL accredited labs are applicable for Imaging Centres.
4. A diagnostic centre empanelled under CGHS, whose normal rates for treatment procedure / test are lower than the CGHS package rates shall charge as per the rates charged by them for that procedure / treatment from a non-CGHS beneficiary and will furnish a certificate to the effect that the rates charged from CGHS beneficiaries are not more than the rates charged by them from non-CGHS beneficiaries.
5. In case of non-emergencies, the beneficiary shall have the option of availing specific treatment / investigation from any of the empanelled diagnostic centre of his / her choice (provided the diagnostic centre is empanelled for that treatment procedure / test), after the same has been advised by CGHS / other Government Specialist / CMO in-charge and permission is obtained from the competent authority.
6. Permission for treatment is granted by CMO in-charge / Additional Director / Joint Director, CGHS in case of pensioners, former Governors, former Vice Presidents, ex-MPs, Freedom Fighters, etc., and by Rajya Sabha / Lok Sabha Secretariat as the case may be in case of sifting Members of Parliament, concerned
Ministry / Department / Organisation in case of serving Government employees, serving employees and pensioners of autonomous bodies covered under CGHS.
7. The empanelled diagnostic centres shall honour permission letter issued by competent authority and provide treatment / investigation facilities as specified in the permission letter.
8. Diagnostic centres shall provide credit facility to the following categories of CGHS beneficiaries (including dependant family members, whose names are entered on CGHS Card) on production of valid permission letter:
• Members of Parliament;
• Pensioners of Central Government drawing pension from central estimates;
• former Vice-presidents, Former Governors and former Prime Ministers;
• Ex-Members of Parliament;
• Freedom Fighters;
• serving CGHS employees;
• serving employees of Ministry of Health & Family Welfare (including attached / subordinate offices under the Ministry of Health & Family Welfare); and
• such other categories of CGHS cardholders as notified by the Government.
9.1 Bills should be submitted to the Office of the Rajya Sabha Secretariat / Lok Sabha Secretariat in case of sitting Members of Parliament and to Additional Director, COHS. Bengaluru, in case of other beneficiaries enlisted above, once in a month.
9.2 Diagnostic centres shall extend credit facility to the above categories of CGHS beneficiaries under emergency / with prior permission irrespective of the CGHS city where they are registered and send the bill to Additional Director, CGHS.
9.3 Bills of serving employees of the Ministry of Health & Family Welfare and the employees if attached / subordinate offices under the Ministry of Health & Family Welfare will be sent directly to the office / officer which / who referred the patients to the diagnostic centre.
9.4.1 In case of emergencies empanelled diagnostic centres shall not demand payment from CGHS beneficiaries on production of valid CGHS card, issued by competent authority of any CGHS City.
9.5 Reimbursement in case of pensioners, former Governors, former Vice Presidents, ex-MPs, Freedom Fighters, etc., is made by CGHS and by Rajya Sabha Secretariat/ Lok Sabha Secretariat in case of sitting Members of Parliament and by concerned Ministry / Department/ Organisation in case of serving Government
employees, serving employees and pensioners of autonomous bodies covered under CGHS.
9.6 Serving Central Government employees and their dependent family members not covered by the CGHS will not be denied treatment at package rates if they approach the diagnostic centres with a proper referral letter from the Ministry / Department in which they are working, after verifying the genuineness of the employee by production of his / her valid identify card issued by the appropriate authority.
9.7 Serving Central Government employees and their dependent family members not covered by the CGHS will not be denied treatment at package rates if they approach the diagnostic centres in emergency condition to the patient. The treatment will given after verifying the genuineness of the employee by production of his / her valid identify card issued by the appropriate authority.
10. In case of treatment taken in emergency in any non-empanelled private diagnostic centres, reimbursement shall be considered by competent authority at CGHS prescribed packages/ rates only.
11. Any legal liability arising out of such services, responsibility solely rests on the diagnostic centre and shall be dealt with by the concerned empanelled diagnostic centre themselves.
12. This Office Memorandum supercedes all earlier instructions relating to empanelment of diagnostic centres for Bengaluru, Chennai and Mumbai.
13. Diagnostic Laboratories, who have not been NABL Accredited and have only applied for NABL Accreditation (being on the panel of CGHS at the time of submission of tender) shall however, be removed from the list of approved Diagnostic Laboratories, if they fail to obtain NABH Accreditation within six months from the date of issue of this Office Memorandum.
14.. It has now been decided that In the list of Diagnostic Laboratories / Imaging Centres enclosed, which have been now approved under the fresh empanelment procedure, and have now signed the fresh Memorandum of Agreement and submitted the appropriate performance guarantee will be eligible to treat CGHS beneficiaries at revised rates with effect from the date of issue of this Office Memorandum.
15. The empanelment shall be for a period of two years or till the next empanelment of hospitals and diagnostic centres, whichever is earlier.
16. This Office Memorandum along with rates for diagnostic laboratories and Imaging Centres under CGHS in Bengaluru, Chennai and Mumbai can be downloaded from the website of CGHS, http://msotransparent.nic.in/cghsnew/index.asp
sd/-
(R.Ravi)
Director
Tag :
CGHS
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