Health Ministry revises CGHS Rates, Simplifies Referral Process, Details

New Delhi: In a move that is likely to be proved beneficial for both the patients and the hospitals, the Union Ministry of Health and Family Welfare has decided to revise the CGHS package rates for all CGHS beneficiaries and simplified the process of referral under CGHS for the benefit of its employees.

The Union Health Department has taken this decision after duly examining the demands from stakeholders and also after considering the increase in costs of various components of health care. 

As per the PIB release, initially, the CGHS package rates of consultation fees, ICU charges and room rent have been revised by the Government. Apart from this, the Union Government has also simplified the process of referral under CGHS for the benefit of its employees.

Earlier the CGHS beneficiary had to visit the CGHS Wellness Center himself and take referral to the hospital. But now, if the CGHS beneficiary is unable to go, he can send someone on his behalf with his documents to the wellness center. The medical officer can refer the beneficiary to go to the hospital after checking the documents. Apart from this, CGHS beneficiary can also take referral through video call.

While the OPD consultation charges were earlier Rs 150, now they have been revised to Rs 350. Similarly, IPD Consultation fees have also been revised from Rs 300 to Rs 350.

Earlier, ICU charges were Rs 862 for NABH + Room rent as per ward entitlement. It has now been revised to Rs 5,400/- (Rs 862 + Rs 4,500/- for Private ward = 5,362- rounded to Rs 5,400) including accommodation for all ward entitlements. Apart from this, the room rent for General Ward, Semi-Private Ward and Private Ward has been revised to Rs 1,500, Rs. 3,000, and Rs.4,500 respectively.

The comparison between existing CGHS rates and revised rates is as follows:

Medical Dialogues had earlier reported that taking cognizance of the basic cost of providing healthcare treatments, the Union health ministry had proposed to increase the treatment rates at almost 600 private hospitals that are empanelled with the Central Government Health Scheme (CGHS).

Due to delayed processing of their reimbursement claims and long-pending dues, the private hospital had already stopped cashless facilities for CGHS patients and left the program last year.

Thereafter, a commission was established by the Union Health Ministry to evaluate the charges imposed on the users, who are primarily active and retired central government officials and their families. Finally, the Union Health Ministry has announced its decision of revising the CGHS rates.

Commenting on the matter, Dr Alex Thomas of the Association of Healthcare Providers (AHPI) India told Medical Dialogues, "We have been raising this issue for a long time and we have been talking to the government officials in this regard for several years. Definitely, we are thankful that the Government has finally initiated the process but they have only announced about the Consultation fee, ICU charges, and Room rent. The rates of diagnostic services including lab tests are yet to be revised."

"So, we have only been granted a small portion for what we had been demanding. The most important thing is that the Government has not addressed the issue concerning the implementation of packages. The rates have not been revised since 2014 and they are still below the cost price. So, unless that happens, it will be very difficult for the hospitals to manage. We hope that the Government will soon take cognisance about this fact," he further added.

To view the PIB release, click here.

Also Read: Health Ministry proposes to revise CGHS rates, AHPI welcomes move