Clarification regarding issue of medicines under CGHS

Clarification regarding issue of medicines under CGHS

No. 2-2/2014/CGHS(HQ)/PPTY / CGHS(P)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, Maulana Azad Road
New Delhi 110 108

Dated: the 23rd December, 2014

OFFICE MEMORANDUM

Subject: Clarification regarding issue of medicines under CGHS

With reference to the above mentioned subject the undersigned is directed to state that the situation arising out of issue of Office Memorandum No 2/2014/CGHS(HQ)/PPTY / CGHS(P) dated the 25th August ,2014 has been engaging the attention of Government for quite some time. Various representations about the difficulties being encountered have been received from different stakeholders i.e., beneficiaries and doctors, necessitating a review of the matter. It was accordingly considered by a Committee under the Chairmanship of AS&DG,CGHS. After careful review and keeping the recommendations of the Committee in mind, the following guidelines are issued to streamline the functioning of the Wellness Centres:

i. The medicines are to be issued as per the CGHS Formulary and guidelines issued by this Ministry in this behalf.

ii. In case the prescribed medicines are not available in CGHS formulary, but are essential for the treatment of the patient, they can be issued / indented by the doctors of the CGHS Wellness Centre on the basis of a valid prescription of the authorized specialist subject to the condition that such medicines are neither dietary supplements/ food items nor banned drugs. Instructions on this issue i.e., non-admissibility of food items etc. issued vide O.M .No. 39-3/2003-04/CGHS/MSD/RS dated 23rd July 2009 and 3rd August 2009 must be followed.

iii. In case of anti-cancer drugs and other life-saving drugs that are not approved by the DCG1 for use in India, each case should be considered by the Expert Committee under the Chairmanship of Special DG(DGHS).

iv. The technical Standing Committee constituted vide 2-2/2014/CGHS(HQ)/PPTY / CGHS(P) dated 27.08.2014 of this Ministry will review addition or deletion of drugs in the CGHS Formulary/ list of Treatment procedures / investigations / listed implants. The Technical Committee will meet once in three months or as per need, whichever is earlier. In the meantime reimbursement for unlisted procedures / implants will be made at the rates approved by AIIMS/GB Pant Hospital / actuals, whichever is less.

2. The O.M. of even number dated 25.08.2014 is superseded to the above extent while O.M. of even number dated 1.10.2014 is withdrawn.

Sd/-

(Bindu Tiwari)
Director, CGHS(P)
(Tel 2306 1831)

Source:http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File866.pdf

The continuous empanelment scheme would be in force initially upto 28th February, 2015 for all CGHS cities except Mumbai.

The continuous empanelment scheme would be in force initially upto 28th February, 2015 for all CGHS cities except Mumbai.

S. No. 11045/36/2012/CGHS/HEC
GOVERNMENT OF INDIA
Central Government Health Scheme
Nirman Bhawan, New Delhi

GUIDELINES FOR CONTINUOUS EMPANELMENT SCHEME FOR EMPANELMENT OF PRIVATE HOSPITALS, DIAGNOSTIC LABORATORIES, EXCLUSIVE EYE CENTRES AND DENTAL CLINICS WITH CGHS.

Background

With a view to ensuring comprehensive health care to CGHS beneficiaries, CGHS has been, apart from the Government Hospitals, empanelling private hospitals, diagnostic laboratories, exclusive eye centres and dental clinics by floating tenders periodically. The last tender process in this context commenced in the January 2014 and through this process package rates for different treatment procedures and investigations have been notified in 2014. As a part of this process, certain hospitals and diagnostic laboratories exclusive eye centres and dental clinics which participated in e-tender process and accepted these rates and also signed MOAs with CGHS have been notified in all CGHS cities except Mumbai.

However, it has been noticed that the number of hospitals, diagnostic laboratories,exclusive eye centres and dental clinics notified in certain cities through the current tender process is not adequate to provide a satisfactory level of Healthcare to CGHS beneficiaries. Also, there has been little or no response in certain other cities, with the result a situation has arisen where CGHS is not in a position to provide to its beneficiaries the requisite healthcare due to lack of adequate number of hospitals, diagnostic laboratories and exclusive eye centres and dental clinics .

Accordingly, it has become necessary to introduce continuous empanelment scheme, under which more hospitals, diagnostic laboratories and imaging centres could be empanelled to take care of inadequacy. In this background, it is proposed to invite willing hospitals, diagnostic laboratories exclusive eye centres and dental clinics to apply for empanelment under CGHS if they fulfill the same eligibility conditions and accept the rates notified by CGHS in 2014.

Empanelment shall be for a period of 2 years or as applicable to other HCOs empanelled earlier through e-tender in 2014 whichever is earlier.

The continuous empanelment scheme would be in force initially upto 28th February, 2015 for all CGHS cities except Mumbai.

Source-http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File859.pdf

Revision of Medical Reimbursement Claim (MRC) Form for CGHS beneficiaries - reg.

New Medical Reimbursement Claim (MRC) Form for CGHS beneficiaries. The Medical Reimbursement Claim Form has been reviewed and further simplified. Separate forms have been developed for serving beneficiaries and pensioner beneficiaries with requirement of minimum information required for processing of the claims. CGHS Order:-

No.S. 11011/9/2012-CGHS (P)

Government of India

Ministry of Health & Family Welfare

CGHS (Policy)

Nirman Bhawan, New Delhi

Dated the 5th June, 2014

OFFICE MEMORANDUM

Sub:- Revision of Medical Reimbursement Claim (MRC) Form for CGHS beneficiaries - reg.

The undersigned is directed to state that it has been the constant endeavour of the Ministry of Health & Family Welfare to improve the facilities under CGHS and simplify / liberalize the procedures to make the Scheme user friendly.

2. In furtherance of the above objective, the Medical Reimbursement Claim Form has been reviewed and further simplified. Separate forms have been developed for serving beneficiaries and pensioner beneficiaries with requirement of minimum information required for processing of the claims. The CGHS beneficiaries are required to submit their medical reimbursement claims in the prescribed forms with requisite documentary evidences to their Department / office or CGHS, as the case may be for further processing and settlement as per approved CGHS rates and guidelines.

3. The following forms have been prescribed:

Form MRC(S) - For Serving CGHS beneficiaries,
Form MRC(P) - For Pensioner CGHS beneficiaries.

Specimen Forms are enclosed
Encl: As Above

sd/-

[V.P. Singh]

Director

Click on following images to save or view:-

Medical Reimbursement Claim Form for Serving Employees Page 1

Medical Reimbursement Claim Form for Serving Employees Page 2

Medical Reimbursement Claim Form for Pensioner Page 1

Medical Reimbursement Claim Form for Pensioner Page 2

Medical Reimbursement Claim Form Annexure-I

Medical Reimbursement Claim Form Annexure-II

Source: http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File692.pdf