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EXTRACT FROM SWAMYS NEWS AUGUST 2011

145

G.I., MH., O.M. S. 14021 / 11/2008-MS, dated 16-6-2011


Recognition of Westfort Hi- Tech Hospital Limited, Thrissur( Kerala ) for
treatment of Central Government employees under CS (MA) Rules, 1944

1.The under signed is directed to say that a number of representations from various hospitals, Central Government Employees Welfare Co- ordination Committees were received in the Ministry of Health and Family Welfare for recognition of Private Hospitals at Thrissur (Kerala) 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 Thrissur (Kerala), the matter has been examined in Ministry and it has been decided to empanel the Westfort Hi – Tech. Hospital Limited, Thrissur (Kerala) 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, Thiruvananthapuram. 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 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 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) Anaesthesia 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, (xviii) Physio therapy charges, etc,(xviii) Nursing care and charges for its services.
  • (b)Cost of implants/ stents/ grafts is reimbursable in addition to packages rates as per CGHS ceiling rates for implants/ stents / grafts 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 centres 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 packages rates.

5.Package rates envisage duration of indoor treatment as follows:-

Up to 12 days  : for specialized (Super Specialities) treatment
Up to 7 days : for other Major Surgeries
Up to 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 AIMS rates, then reimbursement is to be arrived at by calculating admissible amount item –wise(e.g. room rent investigations, cost of medicine , procedure charges, etc) as per approved rates/ actually, 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 Up to Rs. 13,950 General Ward
2 Rs. 13960to 19,530 Semi- Private Ward
3 Rs. 19, 540  and above Private ward
  • The package rates given in rate list are for semi – private ward.
  • 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.A hospital/ diagnostic centre empanelled under CS(MA) Rules, 1944, whose rates for treatment procedure / test are lower than the CGHS prescribed rates shall charge as per actual.

8.

  • The maximum room rent for different categories would be:
    General ward Rs. 1,000 per day
    Semi- private ward Rs. 2,000 per day
    Private Ward Rs. 3,000 per day
    Day care (6 to 8 Hrs) Rs. 500 (Same for all categories)
  • 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 patient, charged for water and electricity supply, lines charges, nursing charges and routine up- keeping.
  • During the treatment in ICCU/ ICU, no separate room rent will be admissible.
  • 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.
  • Semi Private ward is defined as a hospital room where two to three patents are accommodated and which has attached toilet facilities and necessary furnishings.
  • General ward is defined as halls that accommodated four to ten patients.
  • 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, in a particular hospital does not have the ward as per entitlement of the 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 beneficiaries, the beneficiary shall have the option of availing specific treatment / investigation from any of the recognized hospitals of his / her choice (provided the hospital is recognized for that treatment procedure / test), after the specific treatment / investigation has been advised by Authorized Medical Attendant and on production of valid ID card and permission letter from his / her concerned Ministry / Department

10.The recognized hospitals shall honour permission letter issued by competent Authority and provide treatment / investigation facilities as specified in the permission letter.

11.The recognized hospital shall also provide treatment / investigation facilities to the Pensioner CGHS beneficiaries and their dependent and eligible family members at their own rates approved under CS (MA) Rules, whichever is lower. The hospitals shall provide treatment for 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 Addl. 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 recognized hospitals of his/ her choice (provided the hospital is recognized 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 pr 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.In case of treatment taken in emergency in any non – recognized private hospitals, reimbursement shall be considered by Competent Authority at CGHS prescribed package/ rates only.

16.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

17.Any legal liability arising out of such services shall be the sole responsibility and shall be dealt with by the concerned empanelled hospital. Service will be provided by the Hospital as per the terms given above.

18.Ministry of Health and Family Welfare reserves the right to withdraw / cancel the above O.M. without assigning any reason.

19.The order takes effect from the date of issue of O.M

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