Revision of Guidelines regarding simplification of Referral Systems under ECHS

Approval of the Competent Authority to make the provision of a revision of Guidelines regarding simplification of Referral Systems under ECHS:-

No.22D(06)/2019/WE/D(Res)
Government of India
Ministry of Defence
(Department of Ex Servicemen Welfare)
Room No. 221, B Wing Sena Bhawan

New Delhi, Dated 03 February, 2020

To,

The Chief of Army Staff
The Chief of Naval Staff
The Chief of Air Staff

Subject: Revision of Guidelines regarding simplification of Referral Systems under ECHS.

The undersigned is directed to refer to Ministry of Health & Family Welfare OM No. Z15025/117/2017/DIR/CGHS / EHS dated 10th December, 2018, OM NO. Z 15025/35/2019/DIR/CGHS/CGHS (P) dated 29th May, 2019 and OM NO. Z15025/35/2019/DIR/CGHS/CGHS(P) dated 29th May, 2019 and convey the approval of the Competent Authority to make the provision of aforesaid OMs of MoH&FW applicable to ECHS beneficiaries, as here under:-

(i) Referral from ECHS Medical Officer/ ECHS Specialist for consultation with Specialist at Private Hospitals empanelled under ECHS shall be valid for 30 days in the same hospital.

(ii) Referral shall be valid for consultation upto 03 times in the same hospital within 30 days.

(iii) Referral shall be valid for consultation with a maximum of 03 different Specialists, if required during a single visit.

(iv) Advice of ECHS Medical Officer/ Specialist for listed investigations shall be valid for a period of 30 days.

(v)Advice of ECHS Medical Officer/Specia list for listed treatment procedure shall be valid for a period of 03 months.

(vi) If any listed investigation advised by Specialist of empanelled hospital is required urgently as a medical emergency and certified as such may be undertaken at the same hospital.

2.   ECHS beneficiaries aged 75 years and above shall be permitted to seek direct OPD Consultation from Specialists of Private Hospitals Empanelled under ECHS without referral from ECHS However, medicines prescribed will be collected only from Polyclinics. If any investigations/ procedures are advised and are required in emergency, no other authorization is required and the same may be undertaken. However, in non-emergency conditions approval of competent authority is required if any non-listed investigations/procedures are advised. Medicines prescribed will be collected only from Polyclinics .

3.   Critically ill ECHS beneficiaries shall be permitted for follow up treatment in ECHS empanelled Hospitals as per the details given under:

(a) Permission/ Referral for post-operative follow-up treatment in respect of following post-operative conditions requiring frequent Consultation from Specialist at private hospitals empanelled under ECHS need not be re validated from time to time and follow-up treatment may be under taken at CGHS rates without time limit.

(b) The consultation/investigation are permitted under these follow-up The conditions covered are:-

(i) Post Cardiac Surgery Cases including Coronary Angioplasty.

(ii) Post Organ transplant Cases (Liver, Kidney, Heart etc)

(iii) Post Neuro Surgery Cases/ Post brain Stroke cases requiring regular follow-up treatment.

(iv) End Stage Renal Disease/ follow up cases of Liver Failure.

(v) Cancer

(vi) Auto-immune disorder like Rheumatoid Arthritis requiring regular follow-up.

(vii) Neurological disorder like Dementia, Alzheimer’s disease, Parkinsonism etc.

(c) Medicines prescribed may be provided by ECHS Polyclinic.

(d) However, if any non-listed investigation/ procedure are advised, permission/ referral from competent authority shall be required except in emergency.

4.  This issues with concurrence of Ministry of Defence (Finance/Pension) vide their U. No. 32(17)/2019/Fin/Pen (Part) dated 28 . 1.2020.

Sd/-
(A.K.Karn)
Under Secretary to the Govt. of India

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