Empanelment on 29-10-2007 Pune NEW

www.mohfw.nic.in
F. No.S.11011/41/2007-CGHS Desk. II
Government of India,
Ministry of Health & Family Welfare
Department of Health & Family Welfare
***

Nirman Bhawan, New Delhi
Dated the 6th November, 2007.


OFFICE MEMORANDUM

Subject: Empanelment of Hospitals and Diagnostic Centers under CGHS, Pune, for treatment and diagnostic procedures and fixation of package rates.

The undersigned is directed to state that the question of fresh empanelment of Hospitals and diagnostic centers under CGHS, Pune, and fixation of package rates/ rates has been under consideration of the Government. The approved rates are available on the website of CGHS (www.mohfw.nic.in/cghs.html) and may be downloaded / printed. After following the prescribed procedure, the list of Hospitals and Diagnostic Centers approved by the Ministry for empanelment under CGHS, Pune is enclosed as Annexures ‘A’ and ‘B’.

2. 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 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 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 / diagnostic centers empanelled under CGHS shall not charge more than the package rates/ rates.

(e) Expenses on toiletries, cosmetics, telephone bills etc, are not reimbursable and are not included in package rates.

3. 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/ actuals, in case of investigations.

4. a) CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay / pension. The entitlement is as follows:-

S. No.
Basic Pay + Dearness Pay / Basic Pension + Dearness Pension
Entitlement
1.
Upto Rs. 11,250/-
General Ward
2.
Rs. 11,251/- to 15,750/-
Semi-Private Ward
3.
Rs. 15,751/- and above
Private Ward

(Note: The entitlement in case of pensioners depends upon as to whether the contribution is being made on the basis of last pay drawn or on the basis of pension drawn.)

b) The package rates given in rate list are for semi-private ward.

c) It has now been decided that the CGHS pensioner beneficiaries taking treatment in the empanelled hospitals will be entitled for treatment on credit and serving employees will be entitled for reimbursement after payment, as per the package rates/ rates given on the web site at www.mohfw.nic.in/cghs.htm. 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.

5 A hospital / diagnostic centre empanelled under CGHS, whose rates for treatment procedure / test are lower than the CGHS prescribed rates shall charge as per actual.


6. a) The maximum room rent for different categories would be:

General ward Rs.500/- per day
Semi-Private ward Rs.1000/- per day
Private ward Rs.1500/- per day
Day Care (6 to 8 Hrs.) Rs.500/- (same for all categories)

b) Room rent 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 supply, 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.

7. a) In case of non-emergencies, the beneficiary shall have the option of availing specific treatment / investigation from any of the empanelled hospitals/ diagnostic centre of his / her choice (provided the hospital / diagnostic centre is empanelled for that treatment procedure / test), after the specific treatment / investigation has been advised by CGHS / other Government Specialist / CMO i/c and permission is obtained from competent authority.

(Note: Endorsement “Referred to CGHS approved Centre” by either the Specialist or the CMO-in-Charge will not be required for the concerned Ministry / Department to issue permission for treatment in a private empanelled hospital.)

b) Permission for treatment / investigations is granted by CMO Incharge / 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 Members of Parliament, by the Registrar General of Supreme Court and by the Registrar, Delhi High Court in respect of serving and retired judges respectively, by the concerned Ministry /Department/ Organization in case of serving Govt. employees, serving employees and pensioners of autonomous bodies covered under CGHS.

8. The empanelled hospitals / diagnostic centers shall honour permission letter issued by competent authority and provide treatment / investigation facilities as specified in the permission letter.

9. a) The hospital / diagnostic centre shall treat / investigate on credit basis to the following categories of CGHS beneficiaries (incl. dependant family members, whose name is entered in CGHS Card) on production of valid permission letter:

· Members of Parliament
· Pensioners of Central Govt. drawing pension from central estimates
· former Vice-presidents, Former Governors and former Prime Ministers
· Ex-Members of Parliament,
· Freedom Fighters,
· serving CGHS employees,
· such other categories of CGHS cardholders as notified by the Government.

b) Bills should be submitted to the Secretary Generals of Rajya Sabha and Lok Sabha in case of Members of Parliament and to Additional Director / Joint Director, CGHS, Pune, in case of other beneficiaries enlisted above, once in a month.

c) The hospitals / diagnostic centres shall extend credit facility to the above categories of CGHS beneficiaries under emergency / with prior permission irrespective of the CGHS city wherefrom CGHS card is issued and submit the bill, as per prescribed CGHS rates to Additional / Joint Director, CGHS, Pune.

10. In case of emergencies, empanelled hospitals shall not refuse admission nor demand payment from any CGHS beneficiary on production of valid CGHS card, issued by competent authority and provide treatment on credit basis and submit the bills to the concerned authority.

11. 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 Members of Parliament and by concerned Ministry / Department / Organization in case of serving Govt. employees, serving employees and pensioners of autonomous bodies covered under CGHS.

12. During the In-patient treatment of the CGHS 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.

13. In case of treatment taken in emergency in any non-empanelled private hospitals, reimbursement shall be considered by competent authority at CGHS prescribed Package / rates only.

14. 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.

15. Any legal liability arising out of such services shall be the sole responsibility and shall be dealt with by the concerned empanelled hospital / diagnostic centre. Services will be provided by the Hospitals/Diagnostic centers as per the terms of Agreement.

16. The hospitals / diagnostic centres will not refuse permission to Central Government employees or their dependent family members who are not CGHS beneficiaries if they produce certified / attested copies of identity cards issued by the Government of India and have been referred to the hospital / diagnostic centre by the organisation in which they are working.

17. The hospitals / diagnostic centres will give a discount of 5% on every cash payment charged directly from the beneficiaries.

18. This Office Memorandum supercedes all earlier orders relating to empanelment of Hospitals and diagnostic centers for specialized and general purpose treatment and investigations for Pune.

19. A copy of this Office Memorandum along with copy of MOA is placed on the internet at www.mohfw.nic.in/cghs.htm.




(R.RAVI)
DEPUTY SECRETARY TO THE GOVERNMENT OF INDIA
[Tel: 2306 3483]
To

1. All Ministries / Departments of Government of India
2. Director, CGHS, Nirman Bhawan, New Delhi
3. All Pay & Accounts Officers under CGHS
4. Additional Directors / Joint Directors of all CGHS Cities
5. JD(Gr.) / JD(R&H), CGHS, Delhi
6. CGHS Desk-I / Desk–II / CGHS-I / CGHS-II, Directorate General of Health Services , Nirman Bhawan, New Delhi
7. Estt. I / Estt. II / Estt. III / Estt. IV Sections, Ministry of Health & Family Welfare
8. Admn. I / Admn. II Sections of Directorate General Health Services
9. M. S. Section, Ministry of Health & Family Welfare
10. Rajya Sabha / Lok Sabha Secretariat
11. Registrar, Supreme Court of India / Delhi High Court, Sher Shah Road, New Delhi
12. U.P.S.C.
13. Finance Division, Ministry of Health & Family Welfare
14. Deputy Secretary (Civil Service News), Department of Personnel & Training, 5th Floor, Sardar Patel Bhawan, New Delhi
15. PPS to Secretary (H&FW), Min. of Health & Family Welfare
16. PPS to DGHS / AS&FA / AS(DG) / AS & DG, NACO
17. MS of all hospitals and diagnostic centres being empanelled under CGHS, Pune
18. Swamy Publishers (P) Ltd., P. B. No.2468, R. A. Puram, Chennai 600028.
19. Swamy Publishers (P) Ltd., 4855, 24, Ansari Road, Near Sanjeevan
Hospital, Daryaganj, New Delhi 110002.
21 M/s Bahri Brothers, 742 Lajpat Rai Market, Delhi 110 006
22. Shri. Umraomal Purohit, Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi 110001.
23. All staff side members of National Council (JCM).
24. Office of the Comptroller & Auditor General of India, 10 Bahadur Shah Zafar Marg, New Delhi.
25. All Officers / Sections / Desks in the Ministry.
26. Office order folder
27. Guard file


ANNEXURE - A

The following hospitals have been empanelled under CGHS, Pune, with effect from the date of issue of Office Memorandum, No: S.11011/41/2006-CGHS Desk. II


S. No.
Name of the Hospital
Empanelled for
1.
Colony Nursing Home, Navi Peth, Pune 411 030
[Tel: 020 – 2453 2555 / 2453 4555]
Specialised purpose (Obstet, Gynae and Paediatrics).
2.
Deendayal Memorial Hospital, 926 F. C. Road, Shivajinagar, Pune 411 004
[Tel: 020 – 2565 2497 / 2565 1613]
General and Specialised purpose (Cardiology and Cardio-thoracic Surgery, Lithotripsy, Haemodialysis, Oncology, Chemotherapy) and Diagnostic services.
3.
Sant Dnyaneshwar Hospital, ‘Hira Plaza’, Pune – Nasik Highway, Bhosari, Pune 411 039
[Tel: 020 – 2711 9494 / 2712 9494]
General and Specialised purpose (Lithotripsy and Laparoscopy) and Diagnostic services (Clinical Pathology, Biochemistry, CT Scan and USG / Colour Doppler).
4.
N. M. Wadia Institute of Cardiology, 32 Sassoon Road, Pune 411 001
[Tel: 020 – 2612 2936 / 2612 0932]
Super-speciality (Cardiology, Cardiovascular and Cardio-thoracic Surgery).
5.
Aditya Birla Memorial Hospital, Chinchwad, Pune
Multispeciality General purpose and Specialised purpose [Cardiology, Cardiovascular and Cardio-thoracic Surgery, Neurology & Neurosurgery, Urology (including Dialysis, Lithotripsy and Renal Transplant), Orthopaedic surgery including arthroscopic surgery and Joint replacement, Gastroenterology & GI surgery (excluding liver transplant), Oncology (Surgery & Chemotherapy), Paediatrics & Paediatric Surgery, Endoscopic surgery and ENT].
6.
Bhide Hospital, Navi Peth, Pune 411030
Super-speciality [Orthopaedic surgery including arthroscopic surgery and Joint replacement].
7.
Kotbagi Hospital, 163 D. P. Road, Pune
Multispeciality general purpose.
8.
Sushrut Medical Care & Research Society’s Hardikar Hospital, Ganeshkhind Road, Pune.
Super-speciality (Orthopaedic surgery, including arthroscopic surgery and Joint replacement).



(R. Ravi)
Deputy Secretary to the Government of India
[Tel: 2306 3483]


ANNEXURE - B


The following diagnostic centres have been empanelled under CGHS, Pune, with effect from the date of issue of Office Memorandum, No: S.11011/41/2006-CGHS Desk. II


S. No.
Name of the Diagnostic Centre
Empanelled for
1.
A. B. Diagnostic Centre & Polyclinic Pvt. Ltd., BG – 5, Konark Estates, Opp. Poona Club, Bund Garden Road, Pune 411 001
[Tel: 020 – 2611 9736 / 4006 4011]
Laboratory services, USG / Colour Doppler.
2.
Medinova Diagnostic Services, 1319 Jungli Maharaj Road, Shivajinagar, Pune 411 005
[Tel: 020 – 2553 3731 / 2553 4814]
Laboratory services (Clinical Pathology and Biochemistry) and USG / Colour Doppler.
3.
Medivision Diagnostic Centre, Patil Plaza, Ground Floor, Opp. Mitra Mandal, Near Saras Baug, Pune 411009
[Tel: 020 – 2446 8031 / 2446 8033]
Spiral CT, MRI, USG / Colour Doppler, X – Ray and Nuclear scan.
4.
Pai Clinic & Diagnostic Centre, “Abhinav Apartments”, 778 / B – 1, Next to Congress House, Shivajinagar, Pune 411 005
[Tel: 020 – 2567 9919]
Diagnostic services (Laboratory, Mammography and USG / Colour Doppler).
5.
Spect Lab Nuclear Medicine Services, K 2 / 1, Erandawana Co-op. Society, Opp. Dinanath Mangeshkar Hospital, Near Mahendale Garage, Pune 411 004
[Tel: 020 -
Nuclear medicine diagnostic services.

Note: The empanelment of the hospitals and diagnostic centres is subject to the condition that they submit the Memorandum of Agreement and the appropriate bank guarantee to the Director, CGHS, within 45 days of the issue of the Office Memorandum No: S.11011/41/2006-CGHS Desk. II dated the 6th November, 2007.



(R. Ravi)
Deputy Secretary to the Government of India
[Tel: 2306 3483]