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

GOVT. OF INDIA
OFFICE OF THE ADDITIONAL DIRECTOR
C.G.H.S. (HQ)

Sector -12, R.K.Puram, New Delhi-22

Dated: 27.09.2018

OFFICE MEMORANDUM

Sub: Directions to Private HCOs empanelled under CGHS regarding simplification of procedure for treatment at private hospitals empanelled under CGHS/CS (MA) Rule, 1944.

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With reference to the above mentioned subject the undersigned is directed to state that this Ministry has been receiving various complaints regarding difficulties being faced by CGHS beneficiaries in getting the OPD/IPD treatment at Pvt. HCOs after valid referral from the CMO/MO/Govt. Specialist. It has been viewed very seriously by the Competent Authority.

It is observed that the CGHS beneficiaries are facing a lot of resistance from the staff/OPD manager/Doctors of the private HCOs empanelled under CGHS. OPD timing are clubbed with General OPD or OPD for EWS, which is causing inconvenience to the CGHS beneficiaries. OPD Slot for CGHS beneficiaries is also reduced to half an hour. The CGHS beneficiaries are not allowed to seek the consultation from the Senior Doctor or their OPD, so called premium OPD.

It is reiterated that HCOs empanelled under CGHS shall adhere to the term and conditions while providing treatment/investigation facilities to the CGHS beneficiaries. The private HCOs empanelled under CGHS shall provide quality service to CGHS beneficiaries and care may be taken to avoid inconvenience, especially for the Senior Citizen, Cancer Patients and terminally ill patients. Pvt. HCOs shall avoid any discrimination to CGHS beneficiaries.

As per MOA clause No. 18 (9) discrimination against CGHS beneficiaries’ vis-a-vis general patients – “The amount of Performance Bank Guarantee will be forfeited and the CGHS shall have the right to de-recognize the Health Care Organization as the case may be. Such action could be initiated on the basis of a complaint, medical audit or inspections carried out by the CGHS teams at random. The decision of the CGHS will be final”.

All the empanelled HCOs under CGHS Delhi/NCR are hereby warned/directed to follow the specified guidelines laid down in MOA and OMs issued by the Ministry of Health & Family Welfare, Govt. of India from time to time, failing which the Show Cause Notice will be served and action as deemed fit shall be taken.

This issues with the approval of Competent Authority.

Dr. Sanjay Jain
Addl. Director, CGHS (HQ)

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