Cashless treatment for CGHS patients: Lok Sabha QA

Cashless treatment for CGHS patients: Lok Sabha QA dated 02.08.2024

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA

UNSTARRED QUESTION NO. 1930
TO BE ANSWERED ON 2ND AUGUST, 2024

CASHLESS TREATMENT FOR CGHS PATIENTS

1930. SHRI S VENKATESAN:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether the Government is aware of the issues/difficulties being faced by Central Government Pensioners in getting Cashless treatment under CGHS;

(b) whether it is true that Empanelled Private Hospitals are reluctant to give treatment on Cashless basis for CGHS patients forcing them to remit the Charges and get it reimbursed later through CGHS and if so, the details thereof alongwith the reasons therefor; and

(c) the steps/measures taken/proposed to be taken by the Government to ensure Cashless treatment for employees/pensioners under CGHS and the details of action taken against errant hospitals in the matter?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SMT. ANUPRIYA PATEL)

(a) to (c) As per MoU signed between CGHS and empanelled Health Care Organizations (HCOs), all Central Government pensioners and other eligible beneficiaries along with their dependents having a CGHS Card can avail cashless health services through NHA’s IT platforms at CGHS empanelled hospitals and diagnostic centres. Central Government Pensioners facing difficulties in getting cashless treatment have been provided facility to submit their grievances through various means like email to authorities, PG portal, Local Advisory Committees/ Zonal Advisory Committee meetings with Additional Directors of CGHS cities.

Several steps have been taken to ensure Cashless treatment for employees/pensioners under CGHS, which are:

• The steps taken by the department are primarily focused on the timely payment of Empanelled Hospitals. In the month of September 2023, the Department had decided to make all CMO Incharges as Sanctioning Authorities (Three Hundred Forty-Six in total). This decision has enabled the department to reduce the pendency of payments from 5-6 months to the current payment times of 20-25 days.
• A committee was constituted with the task for the revision of CGHS package rates. The committee has submitted the report.
• Upon receiving any complaint, CGHS officials expeditiously resolve the issue by intervening in the matter through nodal officers appointed at every CGHS empanelled HCOs.
• The show cause notices are issued and penalties are imposed on errant HCOs, as per the provision of MoA like forfeiting 15% of PBG, recovery of overcharged amount from pending bills etc.
• HCOs are directed to attend regularly held Zonal Advisory Committee (ZAC) meetings to discuss and resolve the outstanding issues.
• Instructions are issued to HCOs for strict compliance with CGHS guidelines/rules issued by Ministry/ Department from time to time.

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