No. S. 14021/08/2014-MS
Government of India
Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi- 110108
Government of India
Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi- 110108
Dated the 11th June, 2015
OFFICE MEMORANDUM
Sub:
Recognition of Lakshmi Hospital, Diwan’s Road, Ernakulam, Kerala, for
treatment of Central Government employees under CS (MA) Rules, 1944.
The
undersigned is directed to say that the proposal received for
recognition of Lakshmi Hospital, Diwan’s Road, Ernakulam, Kerala, for
treatment of Central Government Employees and their family members under
CS(MA) Rules, 1944 has been examined in this Ministry and found to be
in order. It has been decided to recognized Lakshmi Hospital, Diwan’s
Road, Ernakulam, Kerala, under Central Services (Medical Attendance)
Rules, 1944.
2.
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 non-NABH Thiruvananthapuram rates. The
approved rates are available on the website of CGHS
(http://msotransparent.nic.in/cghsnew/index.asp) and may bedownloaded/printed.
3. 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.
(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.
(c) Treatment charges for new born baby are separately reimbursable in addition to delivery charges for mother.
(d)
Pawana Hospital, Somatane Phata, Tal-Maval, Distt-Pune (Maharashtra)
shall not charge more than the package rates fixed for CGHS, Pune.
(e) Expenses on toiletries, cosmetics, telephone bills etc. are not reimbursable and are not included in package rates.
4. 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/actually, in case of
investigations.
investigations.
5. (a) CS (MA) beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay.
(b) The package rates given in rate list of CGHS are for semi-private ward.
(b) The package rates given in rate list of CGHS 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.
6.
The hospital shall charge from the beneficiary as per the CGHS
prescribed rates or its own rate list whichever is lower. The hospital
shall charge CGHS Non-NABH Thiruvananthapuram rates.
7. (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 supply, linen charges, nursing charges
and routine up keeping.
(c) During the treatment in lCCU/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 hall that accommodates 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.
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.
8.
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 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.
9.
The hospital shall honour permission letter issued by competent
authority and provide treatment/investigation facilities as specified in
the permission letter.
10.
The hospital shall also provide treatment/investigation facilities to
the CGHS beneficiaries and their eligible dependent family members at
its own rates or rates approved under CS (MA) Rules, whichever is lower.
The hospital shall provide treatment to pensioner CGHS beneficiaries
after authentication through verification of valid CGHS Cards.
11.
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.
12.
In case of 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 recognised for
that treatment procedure/test), on production of valid ID card, issued
by competent authority.
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.
In case of treatment taken in emergency in any non-recognised private
hospitals, reimbursement shall be considered by competent authority at
CGHS prescribed Package/rates only.
15.
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.
16.
Further, the Lakshmi Hospital, Diwan’s Road, Ernakulam, Kerala, shall
undertake the pre-investigations/diagnostic tests/consultations/
examinations as a service provider for conducting the Annual Medical
Examination of the Civil Services Group ‘A’ Officers of above 40 years
of age as per the prescribed protocol for Annual Medical Examination, as
per Annexure.
17.
The hospital will not charge the Central Government Employees came for
Annual Medical Examination more than Rs. 2000/- for conducting the
prescribed medical examinations of the male officers and Rs. 2200/- for
female officers, who come to the hospital with the requisite permission
letter from their Department/Ministry concerned. The above rates for
Annual Medical Examination are valid until such time when the above
rates are revised by the Central by the Government.
18.
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.
19.
Ministry of Health & Family Welfare reserves the right to
withdraw/cancel the above recognition without assigning any reason.
20. The order takes effect from the date of issue of the OM.
21.
The authorities of Lakshmi Hospital, Diwan’s Road, Ernakulam, Kerala,
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) within a period of 3 months
from the date of issue of the above mentioned OM failing which the
Hospital will be derecognized (Two original copies of MOU duly signed by
the Hospital to be sent for acceptance). Subject to above, the Hospital
can start treating Central Government employees covered under CS (MA)
Rules, 1944.
22.
A communication in acceptance of the para 21 above may be sent to the
undersigned within a week from the receipt of this Office Memorandum.
sd/-
(R.S. Nayal)
Under Secretary to the Government of India
(R.S. Nayal)
Under Secretary to the Government of India
