While answering to a unstarred question No.695 in Lok Sabha on 27th Feb 2015, Minister of Health and Family Welfare Shri.Jagat Prakash Nadda said there is no CGHS rates for implant then that implant is reimbursed as per AIIMS/GB Pant Hospital rates. However, if a benefi- ciary opts for a specific brand of implant, he/she shall have to give a written under- taking to bear the difference between the cost of that specific brand and the pres- cribed ceiling rate.
The detailed reply is reproduced and given below for your ready reference…
“The total number of CGHS beneficiaries in the country as on date are 36,67,795.
The CGHS has empanelled 750 Health Care Organizations all over the country.
As per reports received from the field, Grants Medical Foundation Pune has restricted the cashless facilities to serious/emergency cases only. Another hospitals in Ranchi ‘Shree Jagannath Hospital and Research Centre’, which was empanelled recently on 17/11/2014 has stopped this facility.
The reason for pendency of payment of hospital bills is insufficient balance of funds available with UTI-ITSL (Bill Clearing Agency) CGHS recoups funds to UTI-ITSL. There was delay in recoupment due to technical reasons. However, efforts are being made to recoup the funds to UTI-ITSL to avoid pendency.
In addition, through internal adjustment, additional funds are being allocated to Pune & Ranchi to clear the pending bills.
CGHS fixes rates for various treatment procedures and investigations through tender process and rates were last notified on 01.11.2014 for Delhi/NCR and on 17.11.2014 for CGHS cities outside Delhi/NCR. AS per the Memorandum of Agreement signed by empanelled hospital with CGHS at the time of their empanelment they are expected to charge as per CGHS package rates only.
CGHS has fixed up ceiling rates for certain implants without specifying any brand name. If there is no CGHS rates for implant then that implant is reimbursed as per AIIMS/GB Pant Hospital rates. However, if a benefi- ciary opts for a specific brand of implant, he/she shall have to give a written under- taking to bear the difference between the cost of that specific brand and the prescribed ceiling rate”.