F.No.2-1/2012/CGHS/VC/CGHS (P)
Government of India
Ministry of Health and Family
Welfare
Department of Health and Family
Welfare
Nirman Bhawan, New Delhi
Dated the 1st October, 2012.
OFFICE MEMORANDUM
Subject: Clarification regarding admissible
/ non-admissible items under CGHS.
The undersigned is directed to refer to the
directions given by Hon’ble High Court of Delhi in the case of Sh. Kanhiya Singh
Vs UOI and others [W.P.(C)9044/2011], regarding admissibility and
non-admissibility of certain items under CGHS, the following clarifications are
issued:-
2. “CGHS Package Rate” means and includes lump
sum cost of inpatient treatment / day care / diagnostic procedures for which a
CGHS beneficiary has been permitted by the competent authority or for treatment
under emergency from the time of admission to the time of discharge including
(but not limited to ) – (i) registration charges, (ii) Admission charges, (iii)
Accommodation charges including patients diet, (iv) Operation charges, (v)
Injection charges, (vi) Dressing charges, (vii) Doctor / consultant visit
charges, (viii) ICU /ICCU Charges, (ix) Monitoring charges, (x) Transfusion
charges, (xi) Anesthesia charges, (xii) Operation theatre charges, (xiii)
Procedural charges / surgeon’s fee, (xiv) Cost of surgical disposables and all
sundries used during hospitalization, (xv) Cost of surgical disposables and all
sundries used during hospitalization, (xv) Cost of medicines, (xvi) Related
routine and essential investigations, (xvii) Physiotherapy charges etc. (xviii)
Nursing care and charges for its services.
3. Cost of Implants / Stents / Grants is
reimbursable in addition to package rates as per CGHS ceiling rates for Implants
/ Stents / Grafts or as per actual, in case there is no CGHS prescribed ceiling
rate.
4. During In-patient treatment of the CGHS
beneficiary, the hospital will not ask the beneficiary or his / her attendant to
purchase separately the medicines / sundries / equipments or accessories from
outside and will provide the treatment within the package rate, fixed by the
CGHS, which includes the cost of all the items.
5. In cases of conservative treatment, where
there is no CGHS package rate, the above mentioned items are admissible – items
wise at CGHS rates or as per AIIMS rates (if there is no CGHS rate) or as per
actual (if there is no CGHS / AIIMS rate) for any item.
6. Package rates envisage up to a maximum
duration of indoor treatment as follows:
12 days for Specialized (Super Specialties)
treatment:
7 days for other Major Surgeries;
3 days for Laparoscopic surgeries / normal
deliveries; and
1day for day care / Minor (OPD)
surgeries.
7. However, if the beneficiary is required to
stay in the hospital for his / her recovery for a period more than the period
covered in the prescribed package rate, in exceptional cases, supported by
relevant medical records and certified as such by the hospital, the additional
reimbursement shall be limited to accommodation charges s per entitlement,
investigations charges at approved rates, and doctors visit charges (not more
than 2 visits per day per visit by specialists / consultants) and cost of
medicines for additional stay). No additional charge on account of extended
period of stay shall be allowed if that extension is due to infection on the
consequences of surgical procedure or due to any improper proceed.
8. The above list is however not exhaustive.
Some patients may require additional facilities/ procedures, which are
admissible depending upon the medical requirements as advised by the treating
doctors/specialists, with proper justification. Therefore, it is not possible to
indicate a comprehensive list of items, which are not admissible. However, the
following items are not admissible for the purpose of reimbursement under
CGHS:
Telephone charges
Toiletries
Sanitary napkins
Talcum powder
Mouth fresheners
[V.P.Singh]
Deputy Secretary to the Government of India
Source:
http://msotransparent.nic.in/cghsnew/index.asp
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