No suspension of cashless services to the CGHS beneficiaries

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

LOK SABHA
UNSTARRED QUESTION NO: 639
TO BE ANSWERED ON 04TH FEBRUARY 2022

“Cashless Facilities to CGHS Beneficiaries”

639 SHRI SHANMUGA SUNDARAM K.
SHRI VELUSAMY P:

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

(a) whether the Government is aware of the fact that several private hospitals empanelled under the Central Government Health Scheme (CGHS) decided to suspend cashless services to the beneficiaries of the health care programme;

(b) if so, the details thereof and the pending amount to be paid to the hospitals both private and Government category;

(c) whether the cashless services to Ex-Servicemen Contributory Health Scheme is also suspended by the hospitals in private sector; and

(d) the steps taken by the Government to ensure un-interrupted cashless services to the beneficiaries?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(DR. BHARATI PRAVIN PAWAR)

(a) to (d):Under the Central Government Health Scheme(CGHS), empaneled Health Care Organizations (HCOs) are required to provide cashless facilities to the eligible CGHS beneficiaries. However, there have been reports that some hospitals are not providing cashless facilities. Suitable action is taken against them whenever such cases come to notice. AMRI Hospital, Bhubneshwar, M/s Charnock Hospitals Pvt. Ltd., Kolkata, Rabindranth Tagore International Institute of Cardiac Sciences, Kolkata and Utkal Hospital, Bhubaneshwar, Fortis Healthcare Limited, Shalimar Bagh, New Delhi and Amar Eye Centre, Naveen Shahdara Delhi have submitted notice to opt out of CGHS.

Under CGHS, during the current Financial Year, HCOs’ bills worth Rs. 1200 crore (approx.) have been paid and bills amounting to Rs. 1100 crore (approx.) are received for payment.

Regarding Ex-Servicemen Contributory Health Scheme (ECHS), as per the information provided by the Ministry of Defence, 174 Health Care Organizations (HCOs) have stopped giving cashless services to ECHS beneficiaries.

Under CGHS, following steps have been taken to ensure uninterrupted cashless services to the beneficiaries:-

(i) Adequate funds are provided to CGHS under the relevant Head of Account for clearance of hospital bills.

(ii) Hospital Bills are regularly processed for settlement and an amount of Rs. 1200 crore (approx.) has already been paid to private hospitals during current Financial Year 2021-22.

(iii) Additional manpower has been mobilised to expedite settlement of hospital claims.

(iv) In June 2021, CGHS has shifted to settlement of bills in paperless mode on the IT Platform of National Health Authority which is an attached Office of Ministry of Health & Family Welfare.

As informed by Ministry of Defence, following steps have been taken for timely payment of bills to the hospitals empanelled under ECHS: –

(i) Provision of adequate budgetary support has been made.

(ii) Usages of IT solution for continuous monitoring for efficient processing of bills and timely payment.

(iii) Empanelment of additional HCOs as an alternative to those who have refused services.

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