CGHS: Revival of Continuous Empanelment of Private Health Care Organization under CGHS Delhi and NCR – Eligibility Criteria / Draft MoA reg.
OFFICE MEMORANDUM
Subject: Revival of Continuous Empanelment of Private Health Care Organization under CGHS Delhi and NCR
With reference to the above mentioned subject, attention is drawn to the Office Memorandum File No. S-11011/03/ 2018-CGHS (HEC) dated 7th February 2020 whereby Continuous empanelment of Health Care Organizations (HCO’s) under CGHS Delhi and NCR were suspended. Since then there are requests from several quarters for review of these directions and the matter has been reviewed by the Ministry and it is now decided to partly revoke the OM dated 7th February 2020 and revive Continuous Empanelment of Health Care Organization (HCO’s) under CGHS Delhi NCR with immediate effect in CGHS Delhi & NCR (Faridabad, Ghaziabad, Gurugram, Noida & Sonipat) in respect of Multi-Speciality Hospitals only (for the present ), as per the revised Continuous Empanelment Scheme 2022, the Office Memorandum enclosing the Application form and Draft MOA of which is placed on CGHS website at the prevalent CGHS package rates and as revised from time to time.
The Continuous Empanelment Scheme 2022 shall be in operation for two years or till further Orders whichever is earlier
(Dr Nikhilesh Chandra)
Director CGHS
Tel. No. 011-23062800
EMPANELMENT OF PRIVATE HOSPITALS, EXCLUSIVE EYE HOSPITALS / CENTRES EXCLUSIVE DENTAL CLINICS, CANCER HOSPITALS/UNITS, DIAGNOSTIC LABORATORIES & IMAGING CENTRES
UNDER CGHS-2022
The Central Government Health Scheme (CGHS) provides comprehensive health Care facilities to the Central Government employees I pensioners and certain other categories of beneficiaries as notified by the Central Government from time to time. With a view to ensuring comprehensive health care facilities to CGHS beneficiaries, CGHS has been empaneling private hospitals, exclusive Eye Hospitals/ Centers, exclusive Dental Clinics, Cancer Hospitals/units , diagnostic laboratories and imaging centers periodically.
In this background, willing hospitals, exclusive Eye hospitals / Centres, exclusive Dental Clinics, Cancer Hospitals/units, diagnostic laboratories and imaging centres are invited to submit their applications for empanelment under CGHS.
The eligible private health Care Organizations seeking empanelment and having prescribed infrastructure and staff and willing to accept the rates of various treatment procedures/ investigations notified by CGHS and other conditions as detailed in the Application document and Memorandum of Agreement (MOA) may apply for the same in the prescribed format .
Under the CGHS Empanelment Scheme 2022 the hospitals, exclusive Eye hospitals / Centres, exclusive Dental Clinics, Cancer Hospitals/units, diagnostic laboratories and imaging centres accredited by National Accreditation Board for Hospitals and Health Care providers (NABH)* / National Accreditation Board for Testing and Calibration Laboratories (NABL) shall be considered for empanelment under CGHS. Non-Accredited HCOs can also apply and shall be considered as per the details given in the succeeding paragraphs.
*The Hospitals accredited by National Accreditation Board for Hospitals and Health Care providers (NABH) or its equivalents such as Joint Commission International (JCI), ACHS (Australia) or by any other accreditation body approved by International Society for Quality in Health Care (ISQua) shall be considered as accredited equivalent to NABH.
- Under the new empanelment Scheme 2022, applications for empanelment shall be submitted only by new HCOs seeking empanelment. Already empaneled HCOs would only fill up undertaking at Annexure IV. All NABH (or Equivalent) /NABL Accredited HCOs (including existing) , which qualify as per the terms and conditions of empanelment shall be empanelled for two years and they shall submit MOA and Performance Bank Guarantee.
- All QCI recommended existing HCOs shall also be empanelled for two years and they shall submit MOA and Performance Bank Guarantee.
- The otherwise eligible Non-NABH/ Non-NABL accredited new HCOs shall be inspected by QCI first and after receipt of recommendation from QCI, they shall be considered for empanelment under CGHS and shall submit MOA and PBG. If new HCOs have already obtained QCI recommendation it must be less than one year old on the date of submission of application for empanelment.
- The applications shall be examined on quarterly basis. Under the continuous empanelment scheme applications received shall be scrutinized on quarterly basis on the last working day in the month of March, June, September and December.
- Differential rates shall be applicable to the private hospitals & diagnostic laboratories and Imaging centres empanelled under CGHS depending on their NABH / NABL accreditation status.
- CGHS also reserves the right to prescribe/ revise rates for new or existing treatment procedure(s) I investigation(s) from time to time.
The applications shall be submitted to the Additional Director, CGHS of concerned City.
PART – I – EMPANELMENT OF HOSPITALS, EXCLUSIVE EYE HOSPITALS / CENTRES, EXCLUSIVEDENTAL CLINICS, CANCER HOSPITALS/UNITS.
PART- II – EMPANELMENT OF DIAGNOSTIC LABORATORIES & IMAGING CENTRES
PART I
(For Empanelment of Hospitals, exclusive Eye hospitals / centres, exclusive Dental clinics, Cancer Hospitals/units, in all CGHS covered cities except Mumbai)
A. MINIMUM NUMBER OF BEDS REQUIRED
(Not for exclusive Eye hospitals/centres & Exclusive Dental clinics)
I) METRO CITIES (EXCEPT MUMBAI) ………… 50
OTHER CITIES …………………………………………. 30
NB: The number of beds as certified in the Registration Certificate of State Government / Local Bodies/ NABH/ Fire Authorities shall be taken as the valid bed strength of the hospital.
B. CATEGORIES OF HEALTH CARE ORGANIZATIONS:
The hospital shall be empanelled for all the facilities available in the hospital (except IVF and other assisted reproductive treatment procedures). In case some facility is available in the hospital but, is not offered to CGHS beneficiaries, the hospital is liable to be removed from CGHS panel.
CGHS would consider the following categories of health care Organizations for empanelment
(a) NABH Accredited Hospitals-
The hospitals applying under this category must be accredited by National Accreditation Board for Hospitals and Health Care providers (NABH) or its equivalent such as Joint Commission International (JCI), ACHS (Australia) or by any other accreditation body approved by International Society for Quality in Health Care (ISQua).
(b) NON NABH Accredited Hospitals-( recommended by QCI)
C. CANCER HOSPITALS/UNITS
Cancer hospitals/units having all treatment facilities for cancer – surgery, Chemotherapy and radio-therapy (approved by BARC / AERB).
(a) NABH Accredited Cancer Hospitals/ Units
(b) Non-NABH Accredited Cancer Hospitals/Units – (recommended by QCI)
D. EXCLUSIVE EYE HOSPITALS/ CENTERS:
No minimum bed strength is prescribed for empanelment of exclusive Eye hospitals/centres
(a) NABH Accredited- Exclusive Eye Hospitals/Centres
(b) Non-NABH Accredited Exclusive Eye Hospitals/ Centres (Recommended by QCI)
E. EXCLUSIVE DENTAL CLINICS
No minimum bed strength is prescribed for empanelment of exclusive Dental Clinics
However there shall be a minimum of ‘2’ Dental chairs for all Dental clinics applying for empanelment under CGHS.
(a) NABH accredited – Exclusive Dental Clinics
(b) Non- NABH accredited – Exclusive Dental Clinics (recommended by QCI)
ELIGIBILITY CRITERIA FOR HOSPITALS/ CANCER HOSPITALS/ EXCLUSIVE EYE CENTRES/ EXCLUSIVE DENTAL CLINICS/STAND ALONE DIALYSIS CENTRE
- The health care Organizations must fulfill the requirements as detailed above depending on the category under which the hospital I exclusive eye hospital / centre, exclusive dental clinic, cancer hospital/unit/ is seeking empanelment and submit copies of the required documents.
- The health care Organization must have been in operation for at least one year. Copy of audited balance sheet, profit and loss account for the last financial year (Main documents only- summary sheet)
- Copy of valid NABH Accreditation in case of NABH Accredited health care Organizations.
- Copy of QCI recommendation (less than one-year-old) in case of Non-NABH accredited health care Organizations.
- List of treatment procedures /investigations/ facilities available in the applicant health care Organization.
- A Demand Draft for Rs.1000/- as application fee (non-refundable) drawn in the name of ‘Pay & Accounts Officer, CGHS in case of Delhi/NCR or in favour of concerned Additional Director in case of CGHS cities outside Delhi, from any Scheduled or commercial or Nationalized Bank.
- A Demand Draft for Rs.1,00,000/- as E.M.D.drawn in the name of ‘Pay & Accounts Officer, CGHS, Delhi/NCR or in favour of concerned Additional Director in case of CGHS cities outside Delhi from any Scheduled or commercial or Nationalized Bank.
- State registration certificate I Registration with Local bodies, wherever applicable.
- Compliance with all statutory requirements including that of Waste Management.
- Fire Clearance certificate and details of Fire safety mechanism as in place in the health care Organization. Exclusive Eye centres, exclusive dental Clinics, have to enclose a certificate regarding fire safety of their premises.
- Registration under PNDT Act, if Ultrasonography facility is available.
- AERB approval for imaging facilities/ Radiotherapy , wherever applicable.
- Certificate of Undertaking in original as per the format annexed.
- Certificate of Registration for Organ Transplant facilities , wherever applicable.
- An Applicant Health care Organization must have the capacity to submit all claims I bills in electronic format to the Bill Clearing Agency and must also have dedicated equipment, software and connectivity for such electronic submission.
- An Applicant Health care Organization must submit the rates for all treatment procedures / investigations/ facilities available with them and as charged by them.
- An Applicant health care Organization must give an undertaking accepting the terms and conditions spelt out in the Memorandum of Agreement (Draft at Annexure V) which should be read as part of this application document.
- Applicant Health care Organizations must certify that they shall charge as per CGHS rates and that the rates charged by them are not higher than the rates being charged from their other patients who are not CGHS beneficiaries. They shall also certify that in case lower rates are charged to any Government I private organization in future, they shall also charge the reduced rates from CGHS beneficiaries.
- Applicant Health care Organizations must certify that they are fulfilling all special conditions that have been imposed by any authority in lieu of special concessions such as but not limited to concessional allotment of land or customs duty exemption.
- Applicant Health care Organizations (except exclusive eye hospitals/centres , exclusive dental clinics/standalone dialysis centre) must agree for implementation of EMR/ EHR as per the standards notified by Ministry of Health & Family Welfare within one year of their empanelment.
- Applicant Hospitals, cancer hospital/units must have minimal annual turnover of Rs.2.00 Crores for Metro cities and Rs.1.00 Crore for Non- Metro cities. Exclusive Eye hospitals/Centres , Exclusive Dental Clinics, must have a minimal annual turnover of Rs. 20 Lacs in Metro Cities and Rs.10 Lacs in Non- Metro Cities. Further, the business from CGHS in the last financial year should not exceed more than 50% of the total business. A certificate to this effect from the Chartered Accountant is to be given by the applicant Health Care Organization.
- Photo copy of PAN Card.
- Name and address of their bankers.
- If several Branches of HCO of the same organization /Group have applied for /empanelled under CGHS in the same city or another city the details shall be submitted.
- Copies of the documents mentioned in Annexure-111 must be submitted(wherever applicable).
PART II
(Diagnostic Laboratories & Imaging Centres)
(For Empanelment in all CGHS covered cities except Mumbai)
CATEGORIES OF DIAGNOSTIC LABORATORIES / IMAGING CENTRES
CGHS would consider the following categories of diagnostic laboratories and imaging centres for empanelment:
a. NABL / NABH accredited Diagnostic Laboratories/ Imaging Centres
b. Non- NABL / Non- NABH accredited Diagnostic Laboratories/ Imaging Centres
ELIGIBILITY CRITERIA FOR DIAGNOSTIC LABORATORIES/ IMAGING CENTRES
- The diagnostic laboratory/imaging centres must fulfill the Criteria as specified above and must submit the copies of the required documents.
- The Diagnostic laboratory/imaging centre must have been in operation for at least one year. Copy of audited balance sheet, profit and loss account for the last financial year (Main documents only- summary sheet-) are to be submitted.
- Diagnostic Laboratories and Imaging Centres must have the capacity to submit all claims I bills in electronic format to the Bill Clearing Agency and must also have dedicated equipment, software and connectivity for such electronic submission.
- Copy of NABL / NABH Accreditation in case of NABL I NABH Accredited Diagnostic Laboratory/ imaging centre.
- Copy of QClrecommendation in case of Non-NABH/Non-NABL accredited laboratories/imaging centres.
- Lists of investigation facilities available with diagnostic lab/imaging centre are to be submitted.
- A Demand Draft for Rs.1000/- as tender document fee (non-refundable) drawn in the name of ‘ Pay & Accounts Officer, CGHS, Delhi/NCR or in favour of concerned Additional Director in case of CGHS cities outside Delhi from any Scheduled or commercial or Nationalized Bank.
- A Demand Draft for Rs.1,00,000/- as E.M.D.drawn in the name of ‘Pay & Accounts Officer, CGHS, Delhi/NCR or in favour of concerned Additional Director in case of CGHS cities outside Delhi from any Scheduled or commercial or Nationalized Bank.
- Diagnostic lab / Imaging Center must have been registered with State Government / Local bodies, wherever applicable.
- Compliance with all statutory requirements including that of Waste Management.
- Documents to establish that fire safety mechanism is in place.
- Registration under PNDT Act, if Ultrasonography facility is available.
- AERB approval for imaging facilities , wherever applicable.
- Certificate of Undertaking as per the format annexed.
- Diagnostic lab / Imaging Center must submit the rates for all investigations services available with it and as charged by it from other patients.
- Diagnostic lab / Imaging Center must give an undertaking accepting the terms and conditions spelt out in the Memorandum of Agreement (Draft at Annexure V) which should be read as part of thisapplication document.
- Diagnostic lab / Imaging Center must certify that they shall charge CGHS beneficiaries as per CGHS rates and that the rates charged by them are not higher than the rates being charged from their patients who are not CGHS beneficiaries.
- Diagnostic lab / Imaging Center must certify that they are fulfilling all special conditions that have been imposed by any authority in lieu of special concessions such as but not limited to concessional allotment of land or customs duty exemption.
- The Diagnostic lab / Imaging center must fulfill the above criteria, wherever applicable and annex copies of relevant documents.
- Minimum annual turnover of diagnostic lab / imaging centre must be 20 lac for Metro cities and Rs. 10 lac for Non-Metro cities. Further, the business from CGHS in the last financial year should not exceed more than 50% of the total business. A certificate to this effect from the Chartered Accountant is to be given by the applicant diagnostic lab/ imaging centre.
- Photo copy of PAN Card.
- Name and address of their bankers.
- Copies of the documents mentioned in Annexure-III must be submitted(wherever applicable).
- If several Branches of HCO of the same organization /Group have applied for /empanelled under CGHS in the same city or another city the details shall be submitted
- In addition the imaging centres shall meet the following criteria:
i. MRI Centre
Must have MRI machine with magnet strength of 1.0 Tesla or more.
ii. CT Scan Centre
Whole Body CT Scanner with scan cycle of less than one second (sub-second) Must have been approved by AERB
iii. X-ray Centre /Dental X-ray/OPG centre
X- Ray machine must have aminimum current rating of 500MA with image intensifier TV system
Portable X-ray machine must have a minimum current rating of 60 MA
Dental X-ray machine must have a minimum current rating of 6 MA OPG X-ray machine must have a current rating of 4. 5 -10 MA
Must have been approved by AERB
iv. Mammography Centre
Standard quality mammography machine with low radiations and biopsy attachment.
v. USG / Colour Doppler Centre
It should be of high-resolution Ultrasound standard and of equipment having convex , sector , linear probes of frequency ranging from 3.5 to 10 MHz should have minimum three probes and provision/facilities of trans Vaginal/ Trans Rectal Probes.
Must have been registered under PNDT Act
vi. Bone Densitometry Centre
Must be capable of scanning whole body
vii. Nuclear Medicine Centre
Must have been approved by AERB / BARC
APPLICATION FORM
Annexure -I is the application format to be filled up and submitted by New HCOs which are not already empanelled under CGHS.
Annexure -IV is to be submitted by the HCOs already empanelled to agree for the terms and conditions of empanelment and CGHS rates and willingness to continue under CGHS.
Hospitals/cancer unit shall fill up Annexure-la
Exclusive Eye hospitals/Centres shall fill up Annexure-lb-Eye
Exclusive Dental Clinics shall fill up Annexure-Ic -Dental
Diagnostic Labs Imaging Centres shall fill up Annexure Id – Lab
Annexure -II is Certificate of Undertaking.
Annexure -Ill is list of documents (wherever applicable) that are to be submitted.
2. DEPOSITION OF FEE FOR APPLICAION AND EMO
Application document fee of Rs. 1000/- (non-refundable) and Earnest Money of Rs. 100,000/-(0ne lac) in the form of Demand Draft from any Scheduled Bank, payable to ‘Pay & Accounts Officer, CGHS Delhi, in case of Delhi and NCR /Concerned Additional Director in case of other cities has to be submitted by the new HCOs. Physical DD shall be delivered along with the Application form.
3. SUBMISSION OF APPLICATION FORMBY NEW HCOS
Completed and duly signed application form along with enclosures (in duplicate) shall be placed in closed envelop. The requisite Demand Draft for Rs. 1000/ and 1,00,000/- shall be enclosed in another closed cover and titled. Both the envelops and shall be enclosed in a sealed covered with address and contact number of the HCO and shall be delivered at the Office of Director (CGHS), Nirman Bhawan, New Delhi in case of Delhi & NCRand at the office of Additional Director of concerned City in other cities.
4. EARNEST MONEY REFUND
- In case the application is rejected on technical grounds Demand Drafts for Earnest Money shall be returned in full.
- In case, the application is rejected after inspection of documents on the grounds of submitting incorrect information then 50% of the Earnest Money would be forfeited and the balance amount would be refunded in due course.
5. TECHNICAL SCRUTINY OF APPLICATIONS
The application forms for empanelment under CGHS shall be opened for initial scrutiny by a team under Additional Director, CGHS of concerned city to verify whether the requisite documents and ODs for Rs.1000/- and Rs.1, 00,000/- are submitted.
In case of incomplete application the same shall be returned along with the DD for Rs.1,00,000/- However, the application fee of Rs.1 , 000/- is non-refundable.
Only one authorized representative shall be allowed to be present at the time of opening of the Application forms.
In case of return of incomplete applications , the deficiencies shall be recorded and signature of authorized representative shall be taken as an acknowledgement.
The applications may be examined on quarterly basis. Under continuous empanelment scheme applications received shall be scrutinized on quarterly basis on the last working day in March, June, September and December.
6. TECHNICAL EVALUATION
The Screening Committee of CGHS under chairmanship of Additional Director, CGHS of concerned city shall examine the applications subsequently to determine whether they fulfill the eligibility criteria.
7. CGHS RATES
All the eligible Hospitals, exclusive eye hospitals / centres, exclusive dental clinics, cancer hospitals/units and diagnostic centres shall agree for CGHS notified rates applicable for semi-private ward. The rates for NABH/NABL accredited HCOs shall be 15% more than the rates for non-accredited HCOs. The CGHS package rates are for semiprivate ward. The rates for CGHS beneficiaries entitled for private ward shall be 15% more than the rates for semi-private ward. The rates for General ward shall be 10% less than the rates of semi private ward. .For cancer surgery Tata Memorial rates as decided by CGHS would apply.
8. OFFER OF EMPANELMENT AND SIGNING OF MEMORANDUM OF AGREEMENT
The health Care Organizations, which are selected for empanelment, will have to enter into an agreement with CGHS for providing services at rates notified by CGHS as per the copy provided at annexure V. This MOA has to be executed on Rs.100/- non-judicial Stamp paper.
They also submit letter of acceptance of CGHS rates.
The terms and conditions in the Draft MOA are considered as part of the Application form.
9. VALIDITY OF CGHS RATES
The prevalent CGHS rates / updates and as revised from time to time shall be valid for the period of agreement.
The empanelled Organizations shall not charge more than CGHS rates.
10. EMR / EHR
The empanelled health Care Organizations (except eye hospital/centre, dental clinics, Diagnostic Labs/Imaging Centres) shall have to implement Electronic Medical Records and EHR as per the standards and guidelines approved by Ministry of Health & Family Welfare within one year of its empanelment.
11. EMPANELMENT WITH AUTONOMOUS BODIES-
All empanelled hospitals/ diagnostic centres/ exclusive eye centres/ exclusive dental clinics shall also agree for empanelment with any autonomous body/ public sector undertaking at CGHS Rates, on the recommendation of Ministry of Health & Family Welfare.
12. PERFORMANCE BANK GUARANTEE (PBG)
Private Hospitals, Exclusive Eye Hospitals / Centres, Exclusive Dental Clinics, Cancer Hospitals/Units, Diagnostic Laboratories & Imaging Centres that are recommended for empanelment after the initial assessment shall also have to furnish a performance Bank Guarantee valid for a period of 30 months i.e. six months beyond the empanelment period, to ensure efficient services and to safeguard against any default:
Hospitals/ Cancer hospitals/units | Rs.10.00 lac |
Eye Hospital/Centre | Rs.2.00 lac |
Dental Clinics | Rs.2.00 lac |
Diagnostic Centre | Rs.2.00 lac |
(PBG for Charitable Health Care Organizations shall be 50% of the above amount)
In case of health care Organizations already empanelled under CGHS, they shall submit a new Performance Bank Guarantee valid for a period of 30 months to cover entire period of empanelment and 6 months beyond.
13. BILLING TO BE IN ELECTRONIC FORMAT
All Billing is to be done in electronic format and medical records need to be submitted in digital format to the Bill Clearing agency (BCA) for necessary processing. In addition to this physical submission of hardcopies will also have to be done to the BCA.
14. FEE FOR PROCESSING OF BILLS/CLAIMS
Bill clearing Agency (BCA) would charge a processing fee @ 2% of claimed amount and service tax thereon with a minimum of Rs.12.50/- and maximum of Rs. 750/- per bill. CGHS reserves the right to revise these charges from time to time.
15. CORRUPT AND FRAUDULENT PRACTICES
“Corrupt practice” means the offering, giving, receiving or soliciting of anything of value to influence the action of the public official.
“fraudulent practice” means a misrepresentation of facts or execution of a contract to the detriment of CGHS, and includes collusive practice among hospitals /authorized representative/service providers designed to hike the bills or misguide the beneficiaries or any such practice adhered to.
CGHS will declare a health care Organization ineligible, either indefinitely or for a stated period of time, to be empanelled if it at any time determines that health care Organization has engaged in corrupt and fraudulent practices in executing contract.
16. INTERPRETATION OF THE CLAUSES IN THE TENDER DOCUMENT
In case of any ambiguity in the interpretation of any of the clauses in the application , the interpretation of Additional Director, CGHS of the clauses shall be final and binding on all parties.
17. LIST OF DOCUMENTS AT ANNEXURE Ill
The documents listed at Annexure lllshall be enclosed with everyapplication.
18. MONITORING AND MEDICAL AUDIT
CGHS reserves the right to inspect the health care Organization at any time to ascertain their compliance with the requirements of CGHS.
Bills of empanelled health care Organizations shall be reviewed periodically for irregularities including declaration of planned procedures / admissions as ’emergencies’, unjustified investigations/treatment , overcharging and prolonged stay, etc., and if any empanelled health Care Organization is found involved in any wrong doings, then the concerned hospitals/other health care Organizations would be suspended/ removed from CGHS panel and would be black listed for specified period for future empanelment with CGHS. Bank guarantee shall also be forfeited.
19. EXIT FROM THE PANEL
The Rates fixed by the CGHS shall continue to hold good unless revised by CGHS. In case the notified rates are not acceptable to the empanelled health care Organizations , or for any other reason, the health care Organization no longer wishes to continue on the list under CGHS, it can apply for exclusion from the panel by giving one month notice. Patients already admitted shall continue to be treated.
20. NODAL OFFICERS
Empanelled health care organizations shall notify two Nodal officers for CGHS beneficiaries , one of them being of the rank of Deputy MS/ Addl. MS, who can be contacted by CGHS beneficiary in case of any eventuality.
21. DISPLAY FOR PUBLIC RATIO OF C-SEC VIS-A-VIS NORMAL DELIVERIES
Empanelled hospital shall agree to display for Public the ratio of C-Sec Deliveries vis-a-vis Normal deliveries near reception and update on Quarterly basis
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