Empanelment of AYUSH Hospitals / Centers under CGHS and CS (MA) Rules for Ayurveda, Unani and Yoga & Naturopathy treatments/procedures and fixation of package rates
Government of India
Ministry of Health & family welfare
Directorate General of Central Government Health Scheme
R K Puram New Delhi-22
Subject:Empanelment of AYUSH Hospitals / Centers under CGHS and CS (MA) Rules for Ayurveda, Unani and Yoga & Naturopathy treatments/procedures and fixation of package rates.
Reference is invited to the OM F.No.Z.28015/01/2006-HD Cell/CGHS (P) dated 1st January 2008 and notification regarding cancellation of the Tender invited for empanelment of AYUSH Hospitals/centers under CGHS and CS (MA) Rules dated 02/11/2011.
In view of this, the Government has considered to empanel list of hospitals recommended by QCI in the cancelled Tender and to offer them the rates for various procedures listed in Annexure “B” of the OM dated 1st January 2008 by extending the same for a period of six months, or till the finalization of new tender whichever is earlier. Accordingly the terms and conditions are as follows subject to signing of Memorandum of Agreement placed on the website within stipulated time period along with submission of Bank Guarantee for Rs.2 Lakhs as per proforma attached.
2.The undersigned is further directed to clarify as under
(a)”Package Rate” means rates for a package of treatment of standard set of procedures that are administered to the patient while undergoing treatment for a pre-diagnosed disease condition for the specified time period. The package rates which are specified for diagnosed diseases/conditions in Annexure “B” should strictly be adhered. Procedures other than the package rates listed in Annexure “B” for a specific disease which is not mentioned under package rates will be considered as per the list and treatments should not exceed 34 days for Ayurveda and 28 days Yoga and Naturopathy in the light of O.M. dated 1-1¬2008.
i)This includes all charges pertaining to a particular treatment/procedure including registration charges, admission charges, accommodation charges, cost of medicines, Panch Karma charges, Labor Room charges, charges for Kshar sutra operation/procedure charges Doctor/Consultant visit charges, Monitoring charges, operation theatre charges, procedural charges/Surgeon’s fee , cost of disposable surgical charges and cost of all sundries used during hospitalization related to routine investigations, physiotherapy charges etc. from the time of admission to till discharge. This also is inclusive of all sub-procedures and related procedures to complete the treatment.
ii) No additional charge on account of extended period shall be allowed if that extension is due to any inproperly conducted procedure.
(b) The rates not indicated in Annexure “B” in respect of items under the head of admission fee, consultation fee, laboratory Investigations/diagnostic tests/procedures, hospitalization Nursing care, Transportation, engagement of attendants etc. will be the same as prescribed for recognized private Allopathic Hospitals under the CGHS.
(c) Re-imbursement for treatment/procedures for which prescribed rates have not been indicated in Annexure “B” will be charged as per actual. The Hospitals are not required to give medicines in OPD or at the time of discharge of the patient. Medicines so provided shall not be reimbursable. Procedures I Treatments given to the beneficiary outside the list will be discouraged if justification is not given for doing outside procedures.
(d) Ward entitlement and rates for room charges will be as prescribed earlier for CGHS beneficiaries. Room rent is applicable only for treatment procedures for which there is no prescribed package rate and 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. Expenses on toiletries cosmetics, telephone bills etc. are not reimbursable and are included in rates/package rates.
(e) The prescribed rates as indicated in Annexure “B” shall be valid for the period of Memorandum of Agreement required to be signed by the Hospital/ Centre with the CGHS.
3. The treatment at these empanelled AYUSH Hospitals/Centers may be taken only with the prior authorization/ permission in accordance with the CGHS Rules or the CS (MA) Rules as the case may be in force at the time of taking treatment.
4.(i) In respect of the CGHS beneficiaries permission for treatment is granted by CMO In-charge! Additional Director / Joint Director, CGHS in case of pensioners, former Governors . Former Vice-president 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 employees and pensioners of case of serving Govt. employees serving employees and pensioners of autonomous bodies covered under CGHS such permission shall be issued on the basis of recommendation from CMO/SMO I/C of the concerned AYUSH dispensary
ii) In respect of the Government employees covered under the CS (MA) Rules, authorization/permission is to be issued by the concerned administrative Ministry/Department based on the recommendations of the AMA of the concerned system of the medicine.
5. The AYUSH Hospitals/Centers will not refuse admission/treatment to Central Government Employees or their dependant 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 organization in which they are working and shall not charge more than the prescribed package rates/ rates in such cases.
6. An AYUSH Hospital/centre empanelled as above, whose rates for treatment procedures/tests are lower than the prescribed rates shall charge as per actual.
7.(a) Hospitals 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.
(b) 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, CGHS (Hqrs), Delhi, in case of other beneficiaries enlisted above, once in a month.
8.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/ Organization in case of serving Govt. employees, serving employees and pensioners of autonomous bodies covered under CGHS.
9. Any legal liability arising out of such services, responsibility solely rests on the hospital 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
10. The Hospitals/Diagnostic centers will give a discount 5% on every cash payment charged directly from the beneficiaries
CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay / pension. The entitlement is as follows:-
Basic Pay (without the inclusion of grade pay)
Up to Rs.13,950/-
Between Rs.13,951/- and Rs.19,530/-
Rs.19,540/- amd above
11.A hospital empanelled under CGHS, whose normal rates for treatment procedure / test are lower than the CGHS prescribed 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.
12.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, carpet, etc. as well as a bed for attendant. The room has to be air-conditioned.
13.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.
14. General ward is defined as halls that accommodate four to ten patients.
15. Normally 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.
16.In case of non-emergencies, the beneficiary shall have the option of availing specific treatment / investigation from any of the empanelled hospitals of his / her choice (provided the hospital 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.
17.This office memorandum is extension of earlier orders dated 01/01/2008 relating to empanelment of AYUSH Hospitals and Diagnostic centers under CGHS
18. A copy of this OFFICE MEMORANDUM along with copy of MOA is placed on the website of Ministry. www.mohfw.nic.in/cdhs/htm
Signed Copy click here