Revamp of CGHS (Central Government Health Services Scheme) Rates
In a significant update, the Union Health Ministry has revised the rates for nearly 2,000 medical procedures under the Central Government Health Services (CGHS) scheme. These changes come into effect from October 13 and are based on accreditation status, hospital type, city classification, and ward entitlement, marking a departure from the previous system.
Background and Issues
- Central government employees and pensioners have complained about being denied cashless treatment at CGHS-empanelled hospitals.
- Patients were often forced to pay upfront and wait for reimbursements.
- Hospitals criticized the outdated package rates, which didn't account for medical inflation since 2014.
New Rate Structure
The revamped rate structure is multi-dimensional, considering:
- Ward Entitlement:
- General ward entitlement sees a 5% decrease in rates.
- Private ward entitlement sees a 5% increase.
- Accreditation:
- Consultation at NABH or NABL-accredited hospitals is at a standard base rate.
- Non-accredited HCOs will have rates 15% less than accredited ones.
- Super-specialty hospitals will have a 15% higher rate.
- City Classification:
- Tier-I cities have standard base rates.
- Tier-II and III cities will have rates 10% and 20% lower than Tier-I, respectively.
- Example: A procedure costing Rs 1,000 in a NABH Tier-I city hospital will cost Rs 850 in a non-NABH facility in the same city. In Tier-II, it would be Rs 900, and in Tier-III, Rs 800.
Rates for radiotherapy, investigations, day-care procedures, and minor procedures remain uniform across wards.
Beneficiaries and Compliance
- CGHS Beneficiaries: Primarily central government employees, pensioners, and their families, covering around 4.26 million people in 80 cities.
- Healthcare organizations must submit an acceptance of the new rates by October 13 or face de-panelment.
- All previous agreements with private hospitals become void from October 13, necessitating fresh empanelment on the CGHS portal.