Private Hospitals/Labs under CGHS–clarification

The Ministry of Health and Family Welfare, New Delhi, has referred to various doubts raised reagarding the CGHS Scheme and issued clarifications. It has been clarified that, if CGHS rate is not available for any treatment procedure in any CGHS covered city, the CGHS rate applicable to the nearest CGHS city or CGHS, Delhi, whichever is lower shall be admissible.  for investigations taken in in house laboratories of hospitals as in patients, the rates applicable to NABL accredited laboratories shall be applicable.  For any any day care procedure requiring short admission — a few hours to one day — accommodation charge for one day as per entitlement shall be applicable, provided the patient has been admitted in a room as per his/her entitlement.  

Full Text of the Office Memorandum dated 30.09.2011 is reproduced below :

OFFICE MEMORANDUM

Subject : Empanelment of private hospitals and Diagnostic Laboratories and Imaging Centres under CGHS- Clarification — regarding rates

With reference to the above mentioned subject the undersigned is directed to draw attention to the CGHS rates notified in 2010 / 2011 applicable to empanelled hospitals and Diagnostic Laboratories and Imaging Centres in Various CGHS cities and to state that in response to the several representations received by this Ministry seeking clarifications regarding CGHS rates applicable, it has now been decided to clarify as under:

1. If CGHS rate is not available for any procedure / investigation / category (say super-specialty) in any CGHS covered city, the CGHS rate notified for such procedure / investigation / category for the nearest CGHS city or the rate notified under CGHS, Delhi, whichever is lower shall be applicable as CGHS rate for such procedure / investigation / category for that city.

2. Since NABL Accreditation for in-house laboratories of hospitals has been made optional, rates prescribed for NABL Accredited laboratories shall be applicable for the in-house laboratories of hospitals, for the investigations under taken for in-patients.

3. It has also been clarified that for any day care procedure requiring short admission — a few hours to one day — accommodation charge for one day as per entitlement shall be applicable, provided the patient has been admitted in a room as per his/her entitlement.

The other terms and conditions shall remain unchanged.

Issues with the concurrence of Finance Division , Min of Health & Family Welfare vide Dy No G1500 dated 27 09.2011.

sd/-
(Jai Prakash)
Under Secretary to Government of India