Thursday, March 5, 2015

CGHS BENEFICIARIES

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
LOK SABHA
UNSTARRED QUESTION NO 695
ANSWERED ON 27.02.2015

CGHS BENEFICIARIES

695 . Yellaiah Shri Nandi
Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:-
(a) the number of CGHS beneficiaries as on date in the country;
(b) whether certain CGHS empanelled hospitals have stopped providing cashless facility to the CGHS beneficiaries due to their huge amount of bills pending for payment;
(c) if so, the details thereof and the reasons for their pendency along with the action taken/ being taken by the Government for clearance of the bills at the earliest;
(d) whether the Government has reduced the entitlement cost of certain package and implants procedures and the CGHS beneficiaries have to pay the difference to the hospitals; and
(e) if so, the details thereof and the reasons therefor along with the corrective218 measures taken/being taken by the Government in this regard?
ANSWER
THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH NADDA)
(a): The total number of CGHS beneficiaries in the country as on date are 36,67,795.
(b) & (c): The CGHS has empanelled 750 Health Care Organizations all over the country.
As per reports received from the field, Grants Medical Foundation Pune has restricted the cashless facilities to serious/emergency cases only. Another hospitals in Ranchi ‘Shree Jagannath Hospital and Research Centre’, which was empanelled recently on 17/11/2014 has stopped this facility.
The reason for pendency of payment of hospital bills is insufficient balance of funds available with UTI-ITSL (Bill Clearing Agency) CGHS recoups funds to UTI-ITSL. There was delay in recoupment due to technical reasons. However, efforts are being made to recoup the funds to UTI-ITSL to avoid pendency.
In addition, through internal adjustment, additional funds are being allocated to Pune & Ranchi to clear the pending bills.
(d)& (e): CGHS fixes rates for various treatment procedures and investigations through tender process and rates were last notified on 01.11.2014 for Delhi/NCR and on 17.11.2014 for CGHS cities outside Delhi/NCR. AS per the Memorandum of Agreement signed by empanelled hospital with CGHS at the time of their empanelment they are expected to charge as per CGHS package rates only.
CGHS has fixed up ceiling rates for certain implants without specifying any brand name. If there is no CGHS rates for implant then that implant is reimbursed as per AIIMS/GB Pant Hospital rates. However, if a beneficiary opts for a specific brand of implant, he/she shall have to give a written under- taking to bear the difference between the cost of that specific brand and the prescribed ceiling rate.
Source: LOKSABHA
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