Reiteration of the guidelines issued by Ministry of Health & Family Welfare, CGHS and Dte. General of Health Services.

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 F. No. 5-36/CGHS (HO/HEC2024)

Office of the Additional Director
Central Government Health Scheme, Headquarter
Ministry of Health and Family Welfare, Government of India
CGHS Bhawan, Sector-13, R.K. Puram, New Delhi - 110066
(Hospital Empanelment Cell) dated 05.08.024

NOTIFICATION

Subject: Reiteration of the guidelines issued by the Ministry of Health & Family Welfare, CGHS, and Directorate General of Health Services.

With reference to the above-mentioned subject, the undersigned is directed to draw attention to the terms and conditions of empanelment under CGHS and to reiterate that the Hospitals, Diagnostic/Imaging, Eye, and Dental centres empanelled under CGHS are required to provide better services to CGHS beneficiaries. The following instructions are to be strictly followed by all Health Care Organizations (HCOs) empanelled under CGHS Delhi/NCR, failing which necessary action will be initiated in accordance with the Memorandum of Agreement (MoA):

  1. Cashless CGHS Facility: This is obligatory for Pensioners, Ex-Members of Parliament, Sitting Members of Parliament, Freedom Fighters, Serving CGHS/DGHS/Ministry of H&FW employees. There is no provision for taking advance Deposit/Payment at the time of admission.
  2. Infection Control Charges: Do not charge the beneficiaries separately for infection control. It is essential for HCOs to maintain infection control at their own cost.
  3. Verification of CGHS Card: Do not demand a photocopy of the CGHS card from the beneficiaries. The CGHS card can be verified from the CGHS app or Digilocker.
  4. Permission for Hospitalization: Hospitalized beneficiaries and emergencies do not require any separate permission letter.
  5. Referral Memo: A stamp is not mandatory on the referral memo.
  6. Prescriptions: Prescriptions must always be given in printed form.
  7. Generic Format: Prescriptions should strictly adhere to the government's policy by being in a generic format.
  8. Dietary Supplements and Cosmetic Items: These should not be included in the prescription.
  9. CGHS Kiosk (Help Desk): Establish a dedicated CGHS Kiosk (Help Desk) within the hospital.
  10. Nodal Officer Information: Ensure that the name of the nodal officer and contact number are prominently displayed. Any changes to the nodal officer must be immediately communicated to this office.
  11. Direct OPD Consultation: CGHS beneficiaries aged 70 years and above shall be permitted to seek direct OPD consultation from specialists of hospitals empanelled under CGHS without a referral from a CGHS Wellness Centre. The terms and conditions remain the same as mentioned in OMs dated 29.05.2019 and 28.06.2024.
  12. Referral Documents: The HCO shall retain a scanned copy of the referral printout and return the original printout to the beneficiary.
  13. Retired Air India Employees: Retired Air India employees with valid CGHS cards are eligible for cashless treatment at all CGHS empanelled Health Care Organizations (HCOs), and their bills are to be processed through the UTI ITSL Portal.
  14. CS (MA) Beneficiaries: CS (MA) beneficiaries and their dependent family members can get treatment at CGHS rates from any of the HCOs recognized under CGHS.
  15. Verification of Bills: Bills are to be verified and signed by the Pensioner beneficiaries at the time of discharge. The same shall be uploaded on the NHA portal.
  16. Guidelines on Diagnostic Tests: The guidelines issued by OM dated 28.06.2024 stated at point B(i) are applicable to Hospitals, Dental, and Eye Care Centres only. In case a CGHS beneficiary wants to get a test done in any other empanelled Diagnostics/Imaging Centre, the test prescribed/advised by the Specialist of Pvt. Empanelled HCOs must be endorsed by the CGHS Wellness Centre.

In case of any complaint regarding excess billing/advance payment/harassment of CGHS beneficiaries, necessary action will be initiated as per the MoA.

R. K. Puram, New Delhi
Dated:5 August 2024

To:
All HCOs empanelled under CGHS Delhi/NCR.

Copy to:

  1. PPS to AS & DG, CGHS, Nirman Bhawan, New Delhi.
  2. PPS to Joint Secretary, CGHS, Nirman Bhawan, New Delhi.
  3. PS to Director, CGHS, CGHS Bhawan, Sector-13, R.K. Puram, New Delhi.
  4. ADDG (HÌ), CGHS Bhawan, Sector-13, R.K. Puram, New Delhi.
  5. All ADs of CGHS Delhi.
  6. Guard File.

(Dr. Honnamma)
Additional Director, CGHS (HÌ)
All Sections of CGHS (HÌ), Delhi.

 

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