Emergency treatment in private empanelled hospital –collecting money by private empanelled hospitals –reg.
SOUTH CENTRAL RAILWAY
Office of the chief Medical Director
Rail Nilayam, Secunderabad
S.No.M D.438/Policy/EOH Date: 19.12.2022
MD/CH/LGD
CMSs/SC,HYB,BZA,GTL,GNT,NED
Sub:- Emergency treatment in private
empanelled hospital –collecting money by private empanelled hospitals –reg.
Ref: 1. Railway Board Lr
No.2018/Transcell/Health/CGHS dated-16.06.2021
2. 144th Zonal PNM Meeting with SCRMU SubNo.144/25/2022- Emergency treatment in Railway empanelled private hospitals-Violation of MOU-reg.
It has come to the notice of the
undersigned that empanelled hospitals are collecting money from the railway
beneficiaries who have gone to private empanelled hospitals in emergency
without referral letters. Detailed procedure is given in Railway Board letter
cited above on how to treat such cases when Railway beneficiary attend
empanelled hospital in emergency without referral letter.
Regarding the admission of Railway beneficiary in emergency for which patient was admitted in the private empanelled hospital should intimate medical emergency to the MD/CMSs though email immediately.
MD/CMSs should immediately communicate
the empanelled hospital within 24 hours and acceptance of the request from
private empanelled hospitals may be communicated with the issue of referral
letter, tll such time private empanelled hospital should not collect any money
from the Railway beneficiaries and after the referral letter issued, railways
has to pay the empanelled hospital as per MoU.
If emergency is not established, till communication of non certification of emergency and till such time medical department has to pay the empanelled hospital as per CGHS rates. After communication of non emergency, for the remaining period up to discharge of the patient, empanelled hospital has to charge the railway beneficiary as per CGHS rates only. Already MoU has been entered with all private empanelled hospital with reference to the Railway Board’s letter cited above.
Several complaints received by the undersigned that the money is being collected by private hospitals from the patients. This is viewed very seriously.
MD/CMSs are advised to call a meeting with all Executives of empallened hospitals to covey about this issue. Hey should stop collecting money from railway beneficiaries and adhere to Railway Board’s letter cited under reference. This issue raised in the Zonal PNM at Headquarter level also.
Please acknowledge the receipt of this letter and early reply is solicited.
DR. Dora Rama Rao
Principal
Chief Medical Director
................................................................................................................................................................
Implementation of Health Delivery System & Emergency Treatment in Railway Empanelled Private Hospitals: Revised Instructions - June 16, 2021
Implementation of Health Delivery
System & Emergency Treatment in Railway Empanelled Private Hospitals:
Revised Instructions
GoI Ministry of Railways (Railway
Board)
No. 2018/Trans.Cell/Health/CGHS dt:
15.06.2021
The General Manager, All Indian
Railways/PUs, NF(Con), CORE The DG/RDSO/Lucknow, DG/NAIR/Vadodara CAOs,
DMW/Patiala, WPO/Patna, COFMOW/NDLS, RWP/Bela, CAO/IROAF
Sub: Implementation of Health
Delivery System & Emergency Treatment in Railway Empanelled Private Hospitals
Revised Instructions.
Ref: Board’s letter no. 2018/TransCell/CGHS dated 28.12.2020
In order to improve the health
delivery system and emergency treatment in railway-empanelled private
hospitals, Board had approved a policy vide letter at Reference (i) above.
Thereafter, a number of suggestions have been received. Based on these
suggestions, Board (Member Finance and Chairman & CEO) have approved the followings:
Rly medical beneficiaries
(serving/rtd) under emergency conditions can get admission in any rly
empanelled hospital without any prior referral. The empanelled hospital should
not insist on referral from rly hospitals or demand advance in emergency
conditions and the hospital will provide cashless/Credit medical facilities to
patients.
The emergency conditions are
defined in Memorandum of Understanding between CGHS empanelled hospitals and
GoI (CGHS Authorities) (Annexure-I) or as amended by CGHS from time to time and
same will be applicable in Indian Railways.
The valid UMID Card/CTSE Card
issued will be treated as identification as Railway Medical Beneficiary.
Railways have to make sure that these cards are accepted in the empanelled
hospital under the jurisdiction/empanelment.
Para 4 of letter dt 28.12.2020 has
been modified as under :
Situation may arise where Railway
hospital, after scrutinizing admission report submitted by empanelled hospital,
finds that the patient is not suffering from an emergency. In such cases, the
hospital bills up to the stage of such determination shall be paid by Railway
directly to Hospital. However, the patient can continue to avail treatment at
the empanelled hospital, if so desired, by paying CGHS rates or hospital rates,
whichever is less on the patient’s cost, thereafter.
The nature and appropriateness of
the emergency is subject to verification, which may be verified, inspected or
medically audited by the nominated authority on a random basis at its own
discretion.
The Hospital will intimate all
instances of patients admitted as emergencies (without prior permission) to the
Rly authorities, at the earliest and within 24 hours and Rly will revert within
next 24 hours, otherwise it will be treated as deemed approval. The empanelled
hospital will clearly mention/certify the emergency condition as per MoU.
Rly Hospital as well as empanelled hospital will share the contact number and email address for communication for this purpose and will ensure to put on the website of Rlys as well as of the hospital. The documents and approvals will be shared on the email to save the time and difficulties faced by the patients. The empanelled Hospital will not insist to patients to get the approval of referral/extension from the Rly Hospital. Same will be coordinated and approved on the contact number and email by the empanelled Hospital and Railway Hospital.
Rly hospitals shall refer to the empanelled hospital for appropriate duration as per the package. In case of additional stay for treatment, same procedure will be followed as per para 6 & 7 above.
Also, the empanelled hospitals will
provide the necessary treatment in OPD or otherwise to valid Rly Medical
Beneficiary at the CGHS approved rates or hospital rates, whichever is less for
the treatment in non-referral and non-emergency case at Railway Medical
Beneficiary’s cost.
Zonal Rlys shall include provisions for conditions given from 4.1 to 4.9 above, in their MoU with the referral hospitals and also include that refusal to provide treatment to bonafide rly medical beneficiaries in emergency cases without valid ground would attract disqualification for continuation of empanelment. Also, MoU to be updated including removal of ambiguities accordingly.
Additional Para 11 has been added to letter dated 28.12.2020 as under :-
The Zonal Railways shall keep above provisions in view, while projecting budget requirement under relevant head. Since expenditure is to be borne by Railways, the bills shall be paid by the Railway Unit which had empanelled the hospital, without making any reference or debit etc. to the Railway Unit to which beneficiary may belong.
Additional Para 12 has been added
to letter dated 28.12.2020 as under :-
Proper accountal & record of such payments may be maintained by Health Department to facilitate audit of such expenditure.
This letter supersedes instructions
contained in Board’s letter no.2018/TransCell/Health/Medical Issues dated
28.12.2020.
This issues with the concurrence of
Associate Finance of Transformation Cell of Railway Board.
Kindly acknowledge the receipt and
ensure compliance.
Sd/- (Umesh Balonda)
Executive Director/S&T
Transformation Cell
Emergency treatment in private empanelled hospitals —collecting money by private empanelled hospitals: South Central Railway Order dated 19.12.2022
SOUTH CENTRAL RAILWAY
Office of the Pr. Chief Medical Director
Rail Nitayam, Secunderabad
सं.No. MD. 434/Policy/EOH
Date-19.12.2022
MO/CHILGD
CMSs/SC, HYG, B24, GTL, GNT NED
Sub: Emergency treatment in private empanelled hospitals —collecting money by private empanelled hospitals – reg.
Ref: 1.Raiway Board Lr No.2018/TransCell/HealthiCGHS dated 16.05.2021
2. 144th Zonal PNM Mealing with SCRMU Sub No. 144/2572022 – Emergency treatment in Railway empanalled private hospitals — Violation of MOU — reg.
It has come to the notice of the undersigned that empanelled hospitals are collecting money from the railway beneficiaries who have gone to private empanelled hospitals in emergency without referral letter. Detailed procedure is given in Railway Board letter cited above on how to treat such cases without Railway beneficiary attend empanelled hospital in emergency without referral letter.
Regarding the admission of railway beneficiary in emergency for which patient was admitted in the private empaneled hospital should intimate medical emergency to the MD/CMSs through email immediately,
MD/CMSs should immediately communicate the empanelled hospitals within 24 hours and acceptance of the request from private empanelled hospitals may be communicated with the issue of referral letter, till such time private empanelled hospital should not collect any money from the Railway beneficiaries and after the referral letter is issued, railways has to pay the empanelled hospital as per MOU.
If emergency is not established, till communication of non certification of emergency and till such time medical department has to pay the empanelled hospital as per CGHS rates. After communication of non emergency, for the remaining period upto discharge of the patient, empanelled hospital has to charge the railway beneficiary as per CGHS rates only. Already MoU has been entered with all private empanelled hospitals with reference to the Railway Board’s erlier cited above.
Several complaints received by the undersigned that the money is being collected by private hospitals from the patients. This is viewed very seriously.
MD/CMSs are advised to call a meeting with all Executes of empanelled hospitals to convey about this issue. They should stop collecting money from railway beneficiaries and adhere to Railway Boards letter cited under reference. This issue raised in the Zonal PNM at Headquarter level also.
Please acknowledge the receipt of this latter and and reply is solicited.
Encl as above
(Dr. Dora Rama Rao)
Principal Chief Medical Director
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