Revision of Ceiling Rates and guidelines for various Coronary Stents for CGHS/CS(MA) beneficiaries

F.No. Misc.1002/2006/CGHS(R&H)/ CGHS(P)

Government of India

Ministry of Health & Family Welfare

Department of Health & Family Welfare

 Maulana Azad Road, Nirman Bhawan

New Delhi 110 108 dated the 21st February, 2013.

OFFICE MEMORANDUM

Subject: Revision of Ceiling Rates and guidelines for
various Coronary Stents for CGHS/CS(MA) beneficiaries.

With reference to the above mentioned subject the
undersigned is directed to draw attention to the Office Memorandum of even
number dated 31.10.2011 and to state that ceiling rates for all DCGI approved
Coronary Stents have been revised In super cession of the Office Memorandum of
even No. dated 31.10.2011 of the Ministry of Health & Family Welfare as per
the ceiling rates mentioned below:

Reimbursement to beneficiaries /empanelled hospitals shall
be allowed subject to the ceiling rates or actuals, whichever are lower.

2.            Coronary
Stents shall be permitted on the advice of Govt. Specialist, of which not more than
two shall be of Drug Eluting Stents( in any of the coronary stents as per the
decision of treating specialist). Permission shall be granted as per the laid
down procedure. If more than two drug eluting stents are implanted in an
empanelled hospital and no written informed consent was obtained from the
beneficiary that he/she would bear the difference in cost between the DES and
Bare Metal Stent, and the hospital has charged this amount from the beneficiary,
the additional amount shall be paid to the beneficiary and shall be deducted
from the pending bills of hospitals.

3.            It is
essential for the empanelled hospitals to quote the Batch number when a
coronary/vascular stent of any type is implanted in the case of a CGHS/CS (MA)
beneficiary and also enclose a copy of the relevant invoices pertaining to the
procurement of the stents by the hospitals. In addition to this, the outer
pouch of the Stent packet along with the sticker on it on which details of the
stent are printed shalt also be enclosed with the medical bill for claiming reimbursement
from the Govt. In case of treatment from a private non-empanelled hospital, where
the treatment was taken in an emergency, it is the responsibility of the
beneficiary to obtain the batch number 1 invoice and outer pouches of the
stent(s) before the submission of the medical claim to CGHS/ concerned
department, as the case may be.

4.            The
empanelled hospital shall submit a self certified undertaking that the hospital
has not charged the CGHS / CS (MA) beneficiary more than the rate at which the
stent has been procured by the hospital and in case of any detection and
establishment that the hospital has overcharged, the hospital shall be removed
from the list of hospitals empanelled under CGHS without any further notice.

5.            UTI-ITSL,
while processing the hospital bills of coronary / vascular stents shall ensure that
the hospitals have enclosed copies of the relevant invoices pertaining to the
procurement of the stents by the hospitals and the outer pouch of the Stent
packet along with the sticker on it on which details of the stent are printed
and that the prescribed rates and the guidelines have been followed, before
making provisional payments to the hospitals.

6.            The
revised rates and guidelines shall come into force from the date of issue and
shall be in force till they are revised.

7.            This
issues with the concurrence of Integrated Finance Division vide Note dated 20.12.2012
of AS&FA, Min. of H&FW.

Sd/-

(RAVI KANT)

UNDER SECRETARY TO GOVERNMENT OF INDIA

Source: http://msotransparent.nic.in

[http://msotransparent.nic.in/writereaddata/cghsdata/mainlinkfile/File577.pdf]