Delay in Payment to Empanelled Hospitals

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA

UNSTARRED QUESTION NO: 4758
ANSWERED ON: 23.03.2018

Delay in Payment to Empanelled Hospitals

RAJIV PRATAP RUDY
Will the Minister of
HEALTH AND FAMILY WELFARE be pleased to state:-

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether there is a delay in the payment to empanelled hospitals under Government sponsored health programmes such as Central Government Health Scheme (CGHS) and Rashtriya Swasthya Bima Yojana (RSBY);

(b) if so, the details thereof and the reasons therefor;

(c) whether CGHS and RSBY has been effective in reducing the burden of out of pocket spending of poor households, if so, the details thereof; and

(d) the total number of beneficiaries and total funds allocated under CGHS and RSBY over the last four years, State/UT wise including Bihar?

ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)

(a) & (b): Under CGHS there is some delay in payment to empanelled hospitals. Following are the reasons for delay in settlement of hospital bills under CGHS:-
i. Resource constraints particularly in the last quarter of Financial Year.
ii. Need for consultation with Specialists in some cases.
iii. Time taken in scrutinizing of Hospital bills.

Under RSBY, Insurance Companies make payment, as due and admissible, to the empanelled hospitals as per their claim. Details are not maintained at Central level.

(c): Under CGHS, the beneficiaries, who are primarily Central Government Employees and Pensioners, are provided health facilities including OPD, medicines, reimbursement of expenditure incurred on hospitalization etc. and they do not have to incur out of pocket expenditure. They have to bear additional expenditure only if they opt for specific brand of implants costing more than CGHS rates.

Under RSBY, claims amounting to Rs. 5012.17 Crore have been settled since 2011-12 to 2016-17, which may be construed as a reduction in out of pocket expenditure for the beneficiaries under RSBY, who have availed the hospitalization benefits.

(d): There are 32,53,219 number of CGHS beneficiaries as on 13.03.2018.
The total funds allocated under CGHS over the last four years is as under:-

Year Funds Allocated (Rupees in Crores)
2013-14 1772.75
2014-15 1734.02
2015-16 1872.29
2016-17 2026.91

Under RSBY no funds are allocated to States. Funds as central share of premium are released on receipt of proposals from State Governments. The State-wise list of beneficiaries under RSBY over the last four years including Bihar is at Annexure.
Source : LokSabha

REVISION OF ECHS RATES FOR EMPANELLED HOSPITALS, DIAGNOSTIC LABORATORIES AND IMAGING CENTRES, MUMBAI

CGHS package rates of Delhi shall be treated as ECHS package rates in Mumbai

Revision of ECHS Rates for Empanelled Hospitals, Diagnostic Laboratories and imaging centres, Mumbai

Central Organisation, ECHS
Adjutant General's Branch
Integrated Headquarters
Ministry Of Defence (Army)
Maude Lines
Delhi Cantt-110 010

B/49773/AG/ECHS/Rates/Policy

05 April 2017

IHQ Of MoD (Navy) Dir ECHS (N)
Air HQ (VB)/DPS
HQ southern Command (A/ECHS)
HQ Eastern Command (A/ECHS)
HQ Western Command (A/ECHS)
HQ Central Command (A/ECHS)
HQ Northern Command (A/ECHS)
HQ South Western Command (A/ECHS)
HQ Andaman & Nicobar Command (A/ECHS)

REVISION OF ECHS RATES FOR EMPANELLED HOSPITALS, DIAGNOSTIC LABORATORIES AND IMAGING CENTRES, MUMBAI

1. Refer GOI MoD ID No 22A (48)/2007/US/WE/D (Res) dt 19 Aug 2010.

2. CGHS rates were revised for all cities except Mumbai in 2014.

3. CGHS has vide its OM S-11011/222017/CGHS-HEC dt 03 Apr 2017 revised the rate of Mumbai from 2010 to Delhi 2014 rates as an interim measure.

4. Regional Centre ECHS Mumbai would disseminate the new rates to empanelled hospitals, diagnostic laboratories and imaging centres, SEMO's Stn HQr's & ECHS polyclinics.

5. The provedures and CGHS package rates of Delhi shall hereafter be treated as ECHS package rates for hospitals, diagnostic laboratories & imaging centres under Regional centre ECHS Mumbai and the rates would be applicable from the date of issue of this letter.

(IVS Gahlot)
Col
Dir (Med)
for MD ECHS

Authority: http://echs.gov.in/

Revision of ECHS Rates for Empanelled Hospitals, Diagnostic Laboratories and imaging centres, Mumbai

Revision of ECHS Rates for Empanelled Hospitals, Diagnostic Laboratories and imaging centres, Mumbai

Tele:25683476
Mil: 36833

Central Organisation, ECHS
Adjutant General's Branch
Integrated Headquarters
Ministry Of Defence (Army)
Maude Lines
Delhi Cantt-110 010

B/49773/AG/ECHS/Rates/Policy

05 April 2017

IHQ Of MoD (Navy) Dir ECHS (N)
Air HQ (VB)/DPS
HQ southern Command (A/ECHS)
HQ Eastern Command (A/ECHS)
HQ Western Command (A/ECHS)
HQ Central Command (A/ECHS)
HQ Northern Command (A/ECHS)
HQ South Western Command (A/ECHS)
HQ Andaman & Nicobar Command (A/ECHS)

REVISION OF ECHS RATES FOR EMPANELLED HOSPITALS, DIAGNOSTIC LABORATORIES AND IMAGING CENTRES, MUMBAI

1. Refer GOI MoD ID No 22A ($*)/2007/US/WE/D (Res) dt 19 Aug 2010.
2. CGHS rates were revised for all cities except Mumbai in 2014.
3. CGHS has vide its OM S-11011/222017/CGHS-HEC dt 03 Apr 2017 revised the rate of Mumbai from 2010 to Delhi 2014 rates as an interim measure.

4. Regional Centre ECHS Mumbai would disseminate the new rates to empanelled hospitals, diagnostic laboratories and imaging centres, SEMO’s Stn HQr’s & ECHS polyclinics.

5. The provedures and CGHS package rates of Delhi shall hereafter be treated as ECHS package rates for hospitals, diagnostic laboratories & imaging centres under Regional centre ECHS Mumbai and the rates would be applicable from the date of issue of this letter.

(IVS Gahlot)
Col
Dir (Med)
for MD ECHS

Government of India
Ministry Of Health and Family Welfare
Department of Health & Family Welfare
Directorate General of CGHS

No.S-11011/22/2017/CGHs-HEC

Nirman Bhawan, New Delhi 110 011
Dated the 3rd April, 2017

OFFICE MEMORANDUM

Subject: Revision of CGHS package rates for empanelled hospitals, diagnostic laboratories and imaging centres under CGHS, Mumbai

with reference to the above mentioned subject attention is drawn to the Office Memoranda Nos.S.11011/23/2009-CGHS D-II/Hospital Cell dt. 15.11.2010 and S.11011/23/2009-CGHS D-II/Hospital Cell (Part-I) dt. 11.04.2011 vide which CGHS package rates have been prescribed for empanelled hospitals, diagnostic laboratories and imaging centres under CGHS, Mumbai and to state that it has now been decided by competent authority to revise the CGHS package for empanelled HCOs under CGHS, Mumbai as per 2014 CGHS rates of Delhi as an interim measure, till further orders.

A list of the procedures and package rates of CGHS Delhi, which shall hereafter be treated as CGHS package rates for hospitals, diagnostic laboratories and imaging centres empanelled under CGHS, Mumbai is enclosed.

Encl. As above

(Dr.D.c.Joshi)
Director, CGHS

Signed Copy

ECHS: Reimbursement limited to 23 days in case 7 days medicines issued by empanelled hospitals

ECHS: Reimbursement limited to 23 days in case 7 days medicines issued by empanelled hospitals

Procedure for reimbursement of Medical expenses under ECHS – Reimbursement limited to 23 days in case 7 days medicines issued by empanelled hospitals

No.22 D(07)/2014/ (WE)/D(Res)

Government of India

Ministry of Defence

New Delhi

Dated : 22nd April, 2015.

 To,
The Chief of Army Staff
The Chief of Naval Staff
The Chief of Air Staff

ADDENDUM

Subject: Procedure for payment and reimbursement of medical expenses under ECHS

Sir,

With reference to Govt. of India, Ministry of Defence letter No.24(8)/03/US(WE)/D(Res) dated 19th December 2003, I am directed to convey the sanction of Competent Authority for following addition to Para 7 of the letter.

2. The reimbursement shall be limited to 23 days in case 7 days medicines have been issued by empanelled hospital for conditions mentioned in para 6 of Govt. of India letter under reference in terms of GOI/MoD letter No.22D(07)/2014/US(WE)/D(Res) dated

3. This issues with the concurrence of Ministry of Defence (Finance) vide their U.O. No 33(207)/2014.Fin/Pen elated 8-4-2015.

Yours faithfully,

H.K Mallick

Under secretary to the Govt. of India

Click here for Original ECHS Order

Criteria for Setting up CGHS Dispensaries/Hospitals

Criteria for Setting up CGHS Dispensaries/Hospitals

The criteria fixed for setting up a Central Government Health Scheme (CGHS) dispensary in a particular area are as under:-

(i) In an existing CGHS city:- For opening of a new Allopathic CGHS dispensary in an existing CGHS city, there has to be a minimum of 2000 Card holders (serving employees of Central Government and Central Civil pensioners).

(ii) Extension of CGHS to a new City:- For extension of CGHS to a new city, there has to be a minimum of 6,000 Card holders.
However, due to financial and other resource constraints it is not always possible to adhere to the above criteria.

State/UT-wise details about number of CGHS allopathic/AYUSH dispensaries and Hospitals in the country is given below:

Source: PIB

Regarding empanelment of 'Delhi Heart and Ling Institute, New Delhi' under CGHS, Delhi

Regarding empanelment of 'Delhi Heart and Ling Institute, New Delhi' under CGHS, Delhi.

 

No:S.11011/07/2014-CGHS (HEC)

Government of India

Directorate General of Central Govt. Health Scheme

 

Shahjahan Road, Bikaner House

New Delhi 110 108, dated the 16th May, 2014

 

Subject: Regarding empanelment of 'Delhi Heart and Ling Institute, New Delhi' under CGHS, Delhi.

 

With reference to the above mentioned matter, attention is drawn to the Office Order of even number dated 14.03.2014 vide which empanelment of Delhi Heart & Lung Institute, New Delhi was suspended from the list of empanelled hospitals under CGHS for a period of six months or till further orders which ever was earlier, as it had withdrawn cashless facilities for CGHS beneficiaries.

 

Now the hospital has agreed to provide cashless facilities to CGHS beneficiaries in terms of MoA signed between CGHS and Delhi Heart & Lung Institute and has assured its compliance thereof, it has been decided to revoke the suspension of CGHS empanelment of Delhi Heart & Lung Institute CGHS with immediate effect till next empanelment in the best of public interest.

 

sd/-

[Dr.D.C.Joshi]

Additional Director CGHS (HQ)

 

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File687.pdf

List of Private Hospitals Removed from Empanelled under CGHS

List of Private Hospitals Removed from Empanelled under CGHS 

While answering a question in Lok Sabha, the Minister of Health and Family Welfare Shri.Ghulam Nabi Azad said that some private hospitals in Delhi NCR are no longer on the list of CGHS empanelled private hospitals.

The details are as under:


1. The following hospitals have opted not to renew their empanelment with CGHS after completion of two years of empanelment. Accordingly they have been removed from CGHS panel w.e.f. 13.02.2013:

(i) Escort’s Heart Institute & Research Centre, New Delhi

(ii) Max Super Specialty Hospital , New Delhi

2. Empanelment of following two hospitals have been suspended:

(i) Max Devki Devi Heart & Vascular Institute, New Delhi (w.e.f. 13.02.2013) as the hospital stopped credit facility to eligible CGHS beneficiaries;

(ii) Bapu Nature Cure Hospital, New Delhi (w.e.f.12.09.2013) on account of deficiency in services.

In addition, the following hospitals in Delhi NCR have been removed w.e.f. 18.12.2012 from the CGHS panel for non-compliance of the terms and conditions of their empanelment with CGHS.

(i) Garg Multispecialty Dental & Research Centre, Ghaziabad

(ii) Jain Hospital, Jagriti enclave, New Delhi

(iii) Kalra Hospital, New Delhi

(iv) Orthonova Hospital, New Delhi

GHS beneficiaries already admitted and undergoing inpatient treatment with prior permission at the time of removal are permitted to complete their treatment at those hospitals.

There is no provision for allowing regular treatment from any private non empanelled hospitals under normal circumstances.

Government has revived continuous empanelment scheme on 14.2.2013 for empanelment of more number of eligible hospitals under CGHS.

CGHS Orders : Revival of ‘Continuous Empanelment Scheme’, for private hospitals and diagnostic centres under CGHS

No: S.11011/23/2009-CGHS D.II/ Hospital Cell (Part IX)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Maulana Azad Road, Nirman Bhawan
New Delhi 110 108 dated the 14th February 2013.

OFFICE MEMORANDUM

Subject: Revival of ‘Continuous Empanelment Scheme’, for private hospitals and diagnostic centres under CGHS.

With a view to ensuring comprehensive health care to CGHS beneficiaries, CGHS has been, apart from the Government Hospitals, empanelling private hospitals and diagnostic centres by floating tenders periodically. The latest tender process in this context commenced in the second half of 2009. Even the already empanelled hospitals (including dental clinics and eye centres) / diagnostic centres under CGHS were required to submit the bids under this tender process. Through this process, package rates for different treatment procedures and investigations were notified in 2010. As a part of this process, certain hospitals and diagnostic centres which accepted these rates and also signed MOAs with CGHS were notified in CGHS covered cities. Subsequently, with a view to empanel more hospitals and diagnostic centers , continuous empanelment scheme was initiated in December 2010 and was in operation till July 2011 in some cities & till 26th December 2011 in some other cities.

2. However, it has been noticed that the number of hospitals and diagnostic centres notified as empanelled under CGHS is not adequate to provide a satisfactory level of health care to CGHS beneficiaries in all areas of CGHS covered cities.

3. Accordingly, it has become necessary to revive ‘Continuous Empanelment Scheme’, to empanel more hospitals and diagnostic centres to take care of existing inadequacy. In this background, it has been decided to invite private hospitals and diagnostic centers to come forward and apply for empanelment under CGHS if, they are willing to accept the rates notified by CGHS in 2010 & as per OM No.Misc.1002/2006/CGHS(R&H)/CGHS (P) dated 6/2/2013 and fulfill the same terms and conditions as notified earlier under ‘Continuous Empanelment Scheme’ except for the following modifications :-

a) Hospitals / Diagnostic centres shall be empanelled for all facilities in all specialties available in the hospitals including those listed under super specialties. Existing hospitals already on panel of CGHS shall not be allowed to add selective specialties/super specialties and will have to offer all available facilities (Undertaking shall be submitted on Rs.100/- non-Judicial Stamp paper attested by Notary Public by hospitals already on panel of CGHS that such hospital shall abide by the terms and conditions of empanelment for the additional facilities and would provide facilities to CGHS beneficiaries in all available specialties/Super specialties (list all the facilities available ) in addition to the agreement signed earlier by such hospitals). The empanelled hospitals will not be permitted to add new specialties or discontinue some specialties subsequently without the approval of the Government.

b) Application under Super Specialty category or change of category to Super Specialty from already empanelled and other eligible hospitals will be considered only if all facilities available in the hospital are offered as per applicable CGHS rates..

c) The scrutiny of the applications and finalization of the lists of eligible hospitals and diagnostic centres of a particular city shall be done by a committee under the chairmanship of AD/JD, CGHS of concerned city with two senior most CMOs of that city as members.

d) Addl. Director / Joint Director of concerned CGHS city may inform the eligible hospitals / diagnostic centres to submit the letters of acceptance of the terms and conditions of the empanelment process. ADs/JDs shall send the details of eligible hospitals / diagnostic centres to Director, CGHS after signing MOA with eligible hospitals/ diagnostic centres and obtaining Performance Bank Guarantee so that the eligible hospitals /diagnostic centres shall be notified by Ministry of Health & Family Welfare as empanelled hospitals / diagnostic centres under CGHS.

4. Empanelment shall be for a period of one year from the date of notification or till new empanelment process , whichever is earlier. All the empanelled hospitals / diagnostic centres shall however, have to participate in the new empanelment process, as and when initiated inorder to continue their empanelment under CGHS.

5. The continuous empanelment scheme would be in force till next empanelment.

6. Further, the undersigned is directed to refer to the Office Memorandum of even number dated 15.12.2012 and to state that it has been decided to extend the validity of empanelment of presently empanelled hospitals, diagnostic laboratories and imaging Centers on the same terms and conditions under which they were empanelled for one year or till next empanelment, whichever is earlier.

7. The application form for the continuous empanelment scheme can be downloaded from the website of CGHS, www.mohfw.nic.in\cghsnew\index.asp.

sd/-
(V. P. Singh]
Deputy Secretary to the Government of India

Source: www.msotransparent.nic.in/cghsnew/index.asp
[http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File574.pdf]

CGHS Orders : Removal / Suspension of Escorts Heart Institute & Research Centre, Max Super Specialty Hospital and Max Devki Heart & Vascular Institute, New Delhi - regarding

No: S.11031/CGHS(HEC)/2012-13-CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare

Maulana Azad Road, Nirman Bhawan
New Delhi 110 108 dated the 13th February 2013

OFFICE MEMORANDUM

Subject : Removal / Suspension of Escorts Heart Institute & Research Centre, Max Super Specialty Hospital and Max Devki Heart & Vascular Institute, New Delhi - regarding

With reference to the above mentioned matter, the undersigned is directed to draw attention to the Office Memorandum No S.11011/23/2009/CGHS DII / Hospital Cell (part I) dated 7.10.2010 vide which Escorts Heart Institute & Research Centre, Max Super Specialty Hospital and Max Devki Heart & Vascular Institute, New Delhi were empanelled under CGHS, Delhi and to state that Escorts Heart Institute & Research Centre and Max Super Specialty Hospital, New Delhi have conveyed their unwillingness to continue their empanelment under CGHS. It is also stated that Max Devki Heart & Vascular Institute, New Delhi informed that the hospital shall not provide credit facility to CGHS beneficiaries. The matter has been examined by this Ministry and it has been decided that Escorts Heart Institute & Research Centre, Max Super Specialty Hospital, New Delhi shall stand removed from the list of empanelled hospitals under CGHS, Delhi with immediate effect.

2. It is further stated that the empanelment of Max Devki Heart & Vascular Institute, New Delhi is suspended from the list of empanelted hospitals under CGHS with immediate effect till further orders.

sd/-
[V.P.Singh]
Deputy Secretary to Government of India

Source : www.msotransparent.nic.in/cghsnew/index.asp
[http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File572.pdf]

Empanelment of Hospitals in Chennai under BSNL MRS - 20.11.2012

Empanelment of Hospitals in Chennai under BSNL MRS

Circle office has issued the list of Empanelment of Hospitals in Chennai for Tamilnadu Circle under BSNL MRS. The MOU period and the agreed rent for the room rent for Hospitals under MOU is also notified.


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Source: http://www.aibsnloatn.org/