Referral to CGHS Empanelled Hospital by name is not permitted

Referral to CGHS Empanelled Hospital by name is not permitted

ECHS has been directed to follow the CGHS Norms  that Referral to CGHS Empanelled Hospital by name is not permitted. According to Norms, a CGHS doctor / Government Specialist shall not refer the beneficiary to any particular empanelled hospital by name but shall specify the treatment procedure and mention “referred to any CGHS empanelled centre.

F.No.18(54)/2018/WE/D(Res-1)
Government of India
Department of Ex Servicemen Welfare
D(WE)

New Delhi, dated 02 August. 2018

To
Managing Director
Ex-servicemen Contributory Health Scheme,
Maude Line,
Delhi Cantt

Subject: Change in System of Referral- No referral to be in the Name of any Private Empanelled Medical Facility.

Sir,
The undersigned is direct to state that as per the Ministry of Health & Family Welfare OM No.Z15025/105/2017/ DIR/CGHS/EHS dated 09.11.2017 the CGHS doctor / Government Specialist shall not refer the beneficiary to any particular empanelled hospital by name but shall specify the treatment procedure and mention “referred to any CGHS empanelled centre”

2. ECHS has to follow the CGHS Norms. However, it is seen that doctors at CHS Polyclinics are issuing referrals by name to specific Pvt. Empanelled Medical Facilities.

3. In view of the above, it has been decided by the competent authority that henceforth no ECHS doctor will issue referrals by name to any Pvt. Empanelled Medical Facility. The ECHS doctors shall mention on the prescription the treatment procedure/tests required by the ECHS beneficiary and then write as follows:

“Referred to any ECHS Empanelled Medical Facility located within the Area of Responsibility of Regional Centre, (Name of City).”

4. CO, ECHS and RC, ECHS will ensure that the list of Pvt. Empanelled Medical Facilities along with the medical treatment procedures/tests for which they have been empanelled is prominently displayed on the website of ECHS, Regional Centre wise. OIC, of every Polyclinic, will be responsible for ensuring that hard copies of this list downloaded from ECHS website is kept in the Polyclinic in sufficient numbers and given to the ECHS beneficiary whenever demanded. If any change lakes place in this list, it shall be the responsibility of Director RC, ECHS concerned ensure display of the corrected/amended list on the website of ECHS without any delay.

5. Whenever an ECHS beneficiary approaches a Pvt. Empanelled Medical Facility with such a referral from ECHS Polyclinic and the Pvt. Empanelled Medical Facility is not empanelled by Ministry of Defence (MoD) for the required treatment procedure / tests, it shall be the responsibility of the Pvt. Empanelled Medical Facility to inform the beneficiary that it is not empanelled for the required treatment procedure / tests. If any Pvt. Empanelled Medical Facility is found providing treatment procedure / conducting tests to such an ECHS beneficiary for which it is not empanelled, then apart from not reimbursing the expenses incurred by the Medical Facility on such treatment, action will be taken against the said ECHS Empanelled Pvt Medical Facility under the rules / as per the provisions of Memorandum of Agreement (MoA).

6. No ECHS Polyclinic Officer/Official/Doctor should indulge in any action force canvassing for/against any ECHS empanelled Pvt. Medical Facility.

7. The above orders shall come into force with immediate effect.

sd/-
(A.K. Karn)
Under Secretary to the Government of India

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