No.S.14021/10/2009-MS
Government of India
Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi
Dated 16th January, 2012
OFFICE MEMORANDUM
Subject :
Recognition of Ashirvad hospital & Research Centre, Varanasi (Uttar
Pradesh) for treatment of Central Government employees under CS(MA)
Rules, 1944.
The undersigned is
directed to say that a number of representations have been received in
the Ministry of Health & Family Welfare for recognition of Ashirvad hospital & Research Centre, Varanasi (Uttar Pradesh) for treatment of Central Government Employees and their family members under CS (MA) Rules, 1944.
2.
In view of the hardships faced by CS(MA) beneficiaries for their own
treatment and the treatment of their family members at Varanasi (Uttar
Pradesh), the matter has been examined in the Ministry and it has been
decided to empanel Ashirvad Hospital & Research Centre, Varanasi
(Uttar Pradesh) under Central Services (Medical Attendance) Rules, 1944.
3.
The Schedule of charges for the treatment of Central Government
Employees and the member of their family under the CS(MA) Rules, 1944,
will be the rates fixed for CGHS, Allahabad. The approved rates are
available on the website of CGHS (www.mohfw.nic.in//cghs.html) and may
be downloaded / printed.
4. The undersigned is further directed to clarify as under:-
(a)
‘Package Rate” shall mean and include lump sum cost of in-patient
treatment/day care/diagnostic procedure for which a CS(MA) 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 patient’s 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 medicines, (xvi) Related routine and
essential investigations, (xvii) Physiotherapy charges etc, (xviii)
Nursing care and charges for its services.
(b)
Cost of Implants is reimbursable in addition to package rates as per
CGHS ceiling rates for implants or as per actual, in case there is no
CGHS prescribed ceiling rates.
(c) Treatment charges for new born baby are separately reimbursable in addition to delivery charges for mother.
(d) Hospitals empanelled under CS(MA) Rules, 1944 shall not charge more than the package rates.
(e) Expenses on toiletries, cosmetics, telephone bills etc. are not reimbursable and are not included in package rates.
5. Package rates envisage duration of indoor treatment as follows:
Upto 12 days: for Specialized (Super Specialities) treatment
Upto 7 days: for other Major Surgeries
Upto 3 days: for Laparoscopic surgeries/normal Deliveries
1 day: for day care/Minor (OPD) surgeries.
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 procedure and is not
justified.
In case, there are no CGHS
prescribed rates for any test/procedure, then AIIMS rates are
applicable. If there are no AIIMS rates, then reimbursement is to be
arrived at by calculating admissible amount item-wise(e.g. room rent,
investigations, cost of medicines, procedure charges etc) as per
approved rates/actual, in case of investigations.
6.
(a) CS(MA) beneficiaries are entitled to facilities of private,
semi-private or general ward depending on their basic pay. The
entitlement is as follows:
S.No. | Pay drawn in pay band | Ward Entitlement |
1. | Upto Rs.13,950/- | General Ward |
2. | Rs.13,960/- to 19,530/- | Semi-Private Ward |
3. | Rs.19,540/-and above | Private Ward |
(b) The package rates given in rate list are for semi-private ward.
(c)
The package rates prescribed are for semi-private ward. If the
beneficiary is entitled for general ward there will be a decrease of 10%
in the rates, for private ward entitlement there will be an increase of
15%. However, the rates shall be same for investigation irrespective of
entitlement, whether the patient is admitted or not and the test,
per-se, does not require admission.
7. The hospital shall charge from the beneficiary as per the CGHS prescribed rates or its own rate list whichever is lower.
8. (a) The maximum room rent admissible for different categories would be:
General ward - Rs.1000/- per day
Semi-private ward - Rs.2000/- per day
Private ward - Rs.3000/- per day
Day care (6 to 8 Hrs.) - Rs.500/- (same for all categories)
(b)
Room rent mentioned above at (a) above is applicable only for treatment
procedures for which there is no CGHS prescribed package rate.
Room
rent will include charges for occupation of bed, diet for the patient,
charges for water and electricity, linen charges, nursing charges and
routine up keeping.
(c) During the treatment in ICCU/ICU, no separate room rent will be admissible.
(d)
Private ward is defined as a hospital room where single patient is
accommodated and which has an attached toilet (lavatory and bath). The
room
should have furnishings like wardrobe, dressing table,
bed-side table, sofa set, etc. as well as a bed for attendant. The room
has to be air-conditioned.
(e) Semi Private ward
is defined as a hospital room where two to three patients are
accommodated and which has attached toilet facilities and necessary
furnishings.
(f) General ward is defined as halls that accommodate four to ten patients.
(g)
Normally the treatment in higher category of accommodation than the
entitled category is not permissible. However, in case of an emergency
when the entitled category accommodation is not available, admission in
the immediate higher category may be allowed till the entitled category
accommodation becomes available. However, if a particular hospital does
not have the ward as per entitlement of beneficiary, then the hospital
can only bill as per entitlement of the beneficiary even though the
treatment was given in higher type of ward.
If,
on the request of the beneficiary, treatment is provided in a higher
category of ward, then the expenditure over and above entitlement will
have to be borne by the beneficiary.
9. In case
of non-emergencies, the beneficiary shall have the option of availing
specific treatment / investigation from any of the recognised hospitals
of his/her choice (provided the hospital is recognised for that
treatment procedure/test), after the specific treatment/investigation
has been advised by Authorised Medical Attendant and on production of
valid ID card and permission letter from his/her concerned
Ministry/Department.
10. The hospital shall
honour permission letter issued by competent authority and provide
treatment/investigation facilities as specified in the permission
letter.
11. The hospital shall also provide
treatment/investigation facilities to the Pensioner CGHS beneficiaries
and their dependent and eligible family members at their own rates or
rates approved under CS(MA) Rules, whichever is lower. The hospital
shall provide treatment to such pensioner CGHS beneficiaries after
authentication through verification of valid CGHS Cards.
12.
However, pensioner CGHS beneficiaries would make payment for the
medical treatment at approved rates as mentioned above and submit the
medical reimbursement claim to the AddI. Director, CGHS through the CMO
i/c of the CGHS Wellness Centre, where the CGHS Card of the beneficiary
is registered.
13. In case of emergencies, the
beneficiary shall have the option of availing specific
treatment/investigation from any of the recognised hospital of his/her
choice (provided the hospital is recognised for that treatment
procedure/test), on production of valid ID card, issued by competent
authority.
14. During the in-patient treatment
of the CS(MA) beneficiary, the Hospital will not ask the beneficiary or
his attendant to purchase separately the
medicines/sundries/equipment
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.
15. If one or more minor procedures form
part of a major treatment procedure, then package charges would be
permissible for major procedure and only 50% of charges for minor
procedure.
16. Any legal liability arising out
of such services shall be the sole responsibility and shall be dealt
with by the concerned empanelled hospital. Services will be provided by
the Hospital as per the terms given above.
17.
Ministry of Health & Family Welfare reserves the right to
withdraw/cancel the above recognition without assigning any reason.
18. The order takes effect from the date of issue of the O.M.
19.
The authorities of Ashirvad Hospital & Research Centre, Varanasi
(Uttar Pradesh) will have to enter into an agreement with the Government
of India to the effect that the Hospital will charge from the Central
Government employees at the rates fixed by the Government and they will
have to sign a Memorandum of Understanding (MOU) (2 copies enclosed only
for Hospital) within a period of 3 months from the date of issue of the
above
mentioned OM failing which the Hospital will be
derecognized. Subject to above, the Hospital can start treating Central
Government employees covered under CS(MA) Rules, 1944.
20. This issues with the concurrence of the Finance Division vide their Dy.No.5177/2011 dated 28.12.2011.
sd/-
(Sanjay Pant)
Under Secretary to the Government of India