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Simplification of procedure for treatment at private hospitals empanelled under CGHS /CS (MA) Rules,1944

Simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rules, 1944 has been examined and it has now been decided

Simplification of procedure for treatment at private hospitals empanelled under CGHS /CS (MA) Rules,1944

Z 15025/105/2017/DIR/CGHS/EHS

Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare EHS Section

Nirman Bhawan, New Delhi
Dated the 9th November,2017

OFFICE MEMORANDUM

Sub: Simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rules, 1944

With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving representations for simplification of procedure for undergoing treatment at private hospitals empanelled under Central Government Health Scheme. The matter has been examined and it has now been decided that CGHS beneficiaries are allowed to undergo treatment at private hospitals empanelled under CGHS of specific treatment procedures listed under CGHS rate list are advised by a Specialist in a Central Government / State Govt. Specialist hospital or a Central Government Health Scheme Medical Officer without any requirement of any other referral (permission) letter.

2. Private empanelled hospitals shall perform the treatment on cashless basis in respect of pensioners, ex-MPs, Freedom Fighters, Regular employees {both Central Government Health Scheme and CS (MA) beneficiaries} of this Ministry & other categories of Central Government Health Scheme beneficiaries, who are presently eligible for credit facility and shall enclose the prescription issued by Government Specialist or a Central Government Health Scheme Medical Officer, in original (or a self-attested photocopy) along with the hospital bill submitted to the competent authorities.

3. Serving government employees shall enclose the prescription issued by a Government Specialist or a CGHS Medical Officer in original (or a self-attested photocopy), while submitting the medical claim to the concerned Ministry /department/office for reimbursement.

4. CGHS Medical Officer / Government Specialist shall not refer the beneficiaries to any particular empanelled hospital by name but, shall specify the treatment procedure and mention ‘referred to any Central Government Health Scheme empanelled centre’.

5.These orders are applicable only in respect of treatment procedures for which CGHS rates are available.

6.This issue with the concurrence of IFD vide FTS No. 3130849, dated 09.11.2017.

S/d,
[Sunil Kumar Gupta]
Under Secretary to Government of India

Tel- 011-2306 1986

Source : Download / Read CGHS and CS(MA) Rules – Simplification of procedure treatment at Private Hospitals OM File No.Z 15025/105/2017/DIR/CGHS/EHS dated 09.11.2017

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