No.S.14021/23/2006-MS
Government of India
Ministry of health & Family Welfare
Nirman Bavan, New Delhi
Dated 20th September, 2012
OFFICE MEMORANDUM
Subject: Recognition of Ratan
Jyoti Netralaya, Gwalior (Madhya 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 Ratan Jyoti Netralaya,
Gwalior (Madhya Pradesh) for treatment of Central Government Employees
and their family members under CS(MA) Rules, 1944.
2. In view of the hardship faced
by CS(MA) beneficiaries for their own treatment and the treatment of
their family members at Gwalior (Madhya Pradesh), the matter has been
examined in the Ministry and it has been decided to empanel Ratan Jyoti
Netralaya, Gwalior (Madhya Pradesh) under Central Services (Medical
Attendance) Rules, 1944.
3. The Schedule of charges for
the treatment of Central Government Employees and the members of their
family under the CS(MA) Rules, 1944, will be the rates fixed for CGHS,
Jabalpur. 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) Ratan Jyoti Netralaya, Gwalior (Madhya Pradesh) 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. 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.
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. Services will be provided by
the Hospital as per the terms given above.
16. Ministry of Health &
Family Welfare reserves the right to withdraw/cancel the above
recognition without assigning any reason.
17. The order takes effect from the date of issue of the O.M.
18. 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.
sd/-
(Arun Chowdhury)
Under Secretary to the Government of India
Source: www.mohfw.nic.in
