No: S.11011/23/2009-CGHS D.II/Hospital Cell (Part I)
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
Maulana Azad Road, Nirman Bhawan
New Delhi 110 108 dated the 16th November , 2010
O F F I C E M E M O R A N D U M
Subject: Fresh empanelment of private hospitals and revision of Room Rent applicable under CGHS.
The undersigned is directed to state that CGHS had initiated action for fresh empanelment of private hospitals under CGHS and also for the revision of package rates (which were fixed in 2006-07), to be paid to hospitals, by floating tender for the same. On the basis of the responses received package rates for various procedures / treatments have been arrived at and have been uploaded in the website of CGHS:www.mohfw.nic.in\cghsnew\index.asp and can be downloaded.
2. “Package Rate” shall mean and include lump sum cost of inpatient treatment / day care / diagnostic procedure for which a CGHS beneficiary has been permitted by the competent authority or for treatment under emergency from the time of admission to the time of discharge including (but not limited to) –
(i) Registration charges, (ii) Admission charges, (iii) Accommodation charges including patients diet, (iv) Operation charges, (v) Injection charges, (vi) Dressing charges, (vii) Doctor / consultant visit charges, (viii) ICU / ICCU charges, (ix) Monitoring charges, (x) Transfusion 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 / stents / grafts is reimbursable in addition to package rates as per CGHS ceiling rates for Implants / stents / grafts 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 chares for mother.
(d) The hospitals empanel led under CGHS shall not charge more than the package rates / rates.
2.2 Package rates envisage upto a maximum duration of indoor treatment as follows:
12 days for Specialised (Super Specialties) treatment;
7 days for other Major Surgeries;
3 days for Lapar oscopic surgeries / normal deliveries; and
1 day for day car e / Minor (OPD) surgeries.
2.3 However, there are certain procedures where there is no prescribed package rate under CGHS. Similarly, there are medical emergencies where the treatment is mainly conservative. The admissible amount in such cases is calculated item wise, room rent, procedures, investigation , etc.,
Therefore, it has now been decided to revise the rates applicable for room rent (Accommodation Charges) for different categor ies of wards as given below:
General ward -Rs.1000/- per day
Semi-private ward -Rs. 2000/ – per day
Private ward -Rs.3000/- per day
3. CGHS beneficiaries are entitled to facilities of private, semi-private or general ward depending on their basic pay / pension. The entitlement is as follows:-
||Basic Pay (without the inclusion of grade pay)
||Upto Rs. 13,950/-
||Between Rs.13,951/ – and Rs.19,530/-
||Rs. 19,540/- and above
4.2 This issues with the concurrence of Internal Finance Division in the Ministry of Health & Family Welfare, vide Dy. No: AS & FA / 3932 /2010 dated the 8th November , 2010.
The revised rates will come into effect from the date of issue of this Office Memorandum.
A copy of this Office Memorandum along with rate list and a copy of MOA are placed on the internet at http://mohfw.nic.in/cghsnew/index.asp.
[R Ravi ]