Recognition of Apollo Speciality Hospital - Madurai (Tamil Nadu) - for treatment of Central Govemment employees under CS(MA) Rules

No. S. 14021/11/1999-MS

Government of India

Ministry of Health & Family Welfare

Nirman Bhavan,NewDelhi,
the 30th April,2009.

OFFICE MEMORANDUM

Subject:- Recognition of Apollo Speciality Hospital, Lake View Road,Madurai-625020 (Tamil Nadu) for treatment of Central Govemment employees under CS(MA) Rules, 1944.

The undersigned is directed to say that a number of representations from various hospitals~ ..Central Government Employees Welfare Coordination 'Committees were received in the ~1inistry of Health & Family Welfare for recognition of Private Hospitals at Madurai (Tamil Nadu) for treatment of Central Government Employees and their family members under CS(MA) Rules, 1944.

2. In view of the hardships faced by CS(MA)· beneficiaries for their own treatment arid the treatment of their family members at Madurai (Tamil Nadu), the matter has been examined in the Ministry and it has been decided to empanel the Apollo Speciality Hospital, Lake View Road, Madurai (Tamil Nadu) under Central Services (Medical Attendance) Rules, 1944.

3.The Schedule' of charges for the treatment of Cent'ral Government Employees and the member of their family under the CS(MA) Rules, 1944, will be the rates fixed for CGHS, Thiruvananthapuram. The approved rates are available on the website of CGHS· (www.mohfw.nic.in//cghs.html) and may be downloaded/printed.

4. The undersigned is further directed to clarify as under:-

(a) "Package Rate" shall mean and include lump sum cost of in-patienttreatment//day care/diagnostic procedure for which a CS(MA) beneficiary has beenpermitted by the competent authority or for treatment under emergency from thetime of admission to the time of discnge, including (but not limited to)-(i)

Registration charges, (ii) Admission charges, (iii) Accommodation charges including patient's diet, (iv) Operation charges, (v) Injection charges, (vi) Dressingcharges, (vii) Doctor/consultant visit charges, (xi) Anesthesia charges, (xii) Operation theatre charges, (xiii) Procedural charges / Surgeon's fee, (xiv) Cost of surgical disposables and all sundries used during hospitalization, (xv) Cost of. medicines, (xvi) Related routine and essential investigations, (xvii) Physiotherapy charges etc, (xviii) Nursing care and charges for its services .

(b) Cost of Implants is reimbursable in addition to package rates as perCGHSceiling rates for implants or as per actual, in case there is no CGHS prescribed ceiling rates.

. (c) Treatment charges for new born baby are separately reimbursable in addition to delivery charges for mother.

(d)Hospitals/diagnostic centers empanelled under CS(MA) Rules, 1944 shall not charge more than the package rates.

(e) Expenses on toiletries, cosmetics, telephone bills etc. are not reimbursable and are not included in package rates.

5. Package rates envIsage duration of indoor treatment as follows: Upto 12 days: for Specialized (Super Specialties) treatment
Upto 7 days: for other Major Surgeries
Upto 3 days: for Laparoscopic sUrgeries/normal Deliveries
"1 day: for day care/Minor (OPD) surgeries.
No additional charge on account of extended period of stay shall be allowed if that extension is due to 'infection on the consequences of surgical procedure or due to any improper procedure and is not justified.
In case, there are no CGHS prescribed rates for any test/procedure, then. AIIMS rates are applicable. If there are no AIIMS rates, then reimbursement is to be arrived at by calculating admissible amount item-wise( e.g. room rent, investigations, cost of medicines, procedure charges etc) as per approved rates/actually,incaseofinVestigations.

6. (a) CS(MA) beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay. The entitlement is as follows:-
S.No. Basic Pay +Dearness Pay Entitlement
1. Upto Rs. 11,250 ..... General Ward
2. Rs. 11,251 to 15,750..... Semi-Private Ward
3. Rs. 15,751 and above..... Private Ward
(b) The package rates given in rate list are for semi-private ward.
(c) The package rates prescribed are for semi-private ward. If the beneficiary is entitled for general ward there will bea decrease of 10% in the rates; for private ward entitlement there will be an increase of 15%. However, the rates shall be same. for investigation irrespective of entitlement, whether the patient is a4mitted or not and the test; per-se, does not require admission.

7. A hospital/diagnostic centre empanelled under CS(MA) Rules, 1944, whose rates for treatment procedure/test are lower than the CGHS prescribed rates shall charge as per actual.

8. (a) The maximum room rent for different categories would be:
General ward..... Rs. 500/- per day
Semi-private ward..... Rs. 1000/- per day
Private Ward .... Rs.1500/- per day
Day care{6 to 8 Hrs.)..... Rs.500/- (same for all categories)·
(b) Room rent mentioned above at (a) above is applicable only for treatmentprocedures for which there is no CGHSprescribed package rate. Room rent wiilinclude charges for occupation of Bed, diet for the patient, charges for water andelectricity supply, linen charges, nursing charges and routine up keeping.
(c) During the treatment in ICCU/ICU, no separate room rent will beadmissible.
(d) Private ward is defined as a hospital room where single patient ISaccommodated and which has an attached toilet (lavatory and bath). The roomshould have furnishings like wardrobe, dressing table, bed-side table, sofa set, etc. as well as a bed for attendant. The room has to be air-conditioned.
(e) Semi Private ward is defined as a hospital room where two to three patients are accommodated and which has attached toilet facilities. and necessary furnishings.
(f) General ward is defined as halls that accommodate fow to ten patients.
(g) Normally the treatment in higher category of accommodation than the entitled category is not permissible. However, in case of an emergency when the entitled category accommodation is not available, admission in the immediate higher category may be allowed till the entitled category accommodation becomes available. However, if a particular hospital does not have the ward as per entitlement of beneficiary, then the hospital can only bill as per entitlement of the beneficiary even though the treatment was given in higher type of ward.
If, on the request of the beneficiary, treatment is provided in a higher category of ward, then the expenditure over and above entitlement will have to be borne by the beneficiary.

9. In case of non-emergencies, the beneficiary shall have the option of availing specific treatment/investigation from any of the above mentioned hospitals of his/her. choice (provided the hospital is recognised for that treatment procedure/test), after the specific treatment/investigation has been advised by Authodsed Medical Attendant and production of valid ID card and permission letter from his/her concerned Mitiistry/Department.

10. The recognised hospitals shall honor permission letter issued by competent authority· and provide treatment/investigation facilities as specified in thepermission letter.

11. In case of emergencies, the beneficiary shall have the option of availingspecific treatment/investigation from -any of the above mentioned hospitals ofhislher choice (provided the hospital is recognised for that treatmentprocedure/test), on production of valid ID card, issued by competent authority.

12. During the in-patient treatment of the CS(MA) beneficiary, the Hospital willnot ask the beneficiary or this attendant to purchase separately themedicines/sundries/equipment or accessories from outside and will provide the treatment within the package rate, fixed by the CGHS which includes the cost of all the items.

13. In case of treatment taken in emergency in any non-recognised private hospitals, reimbursement shall be considered by competent authority at CGHS prescribed Package/rates only.

14. If one or more minor procedures form part of a major treatment procedure, then package charges would be pennissible for major procedure and only 50% of charges for minor procedure.

15. Any legal liability arising out of such services shall be the sole responsibility and shall be dealt with by the concerned empanelled hospital. Services will be provided by the Hospitals as per the tenns given above.

16. Ministry of Health & Family Welfare reserves the right to withdraw/cancel the above O.M. without assigning any reason.

17. The orders takes effect from the date of issue os the O.M.

18. The authorities of Apollo Speciality Hospital, Lake View Road, Madurai (Tamil Nadu) will have to enter into an agreement with the Government of India to the effect that the Hospital will charge from the Central Government employees at the rates fixed by the Government and they will have to sign a Memorandum of Understanding (MOU)(2 copies enclosed only for Hospital) within a period of 3months from the date of issue of the above mentioned OM failing which the Hospital will be derecognized. Subject to above, the Hospital can start treating Central Government employees covered under CS(MA) Rules, 1944.