Cashless Facilities to CGHS/ ECHS: Lok Sabha QA

Cashless Facilities to Central Government Health Scheme (CGHS)/ Ex-Servicemen Contributory Health Scheme (ECHS): Lok Sabha QA

GOVERNMENT OF INDIA
MINISTRY OF HEALTH AND FAMILY WELFARE
DEPARTMENT OF HEALTH AND FAMILY WELFARE
LOK SABHA

UNSTARRED QUESTION NO. 1112
TO BE ANSWERED ON 03rd DECEMBER 2021

Cashless Facilities to CGHS/ ECHS

1112. SHRI SHANMUGA SUNDARAM K.:
SHRI VELUSAMY P.:

Will the Minister o9 HEALTH AND FAMILY WELFARE be pleased to state:

(a) whether the Government is aware of the fact that several private hospitals empanelled under the Central Government Health Scheme (CGHS)/ Ex-Servicemen Contributory Health Scheme (ECHS) have suspended cashless services to the beneficiaries of the said healthcare programme;

(b) if so, the details thereof and the pending amount to the hospitals both private and Government Hospital; and

(c) the steps taken by the Government to ensure un-interrupted cashless services to the beneficiaries?

ANSWER

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (c): Under the Central Government Health Scheme(CGHS), empaneled Health Care Organizations (HCOs) are required to provide cashless facilities to the eligible CGHS beneficiaries. However, there have been reports that some hospitals are not providing cashless facilities. Suitable action is taken against them whenever such cases come to notice. AMRI Hospital, Bhubneshwar, CARE Hospital, Bhubneshwar, SAL Hospital, Ahmedabad, M/s Charnock Hospitals Pvt. Ltd., Kolkata, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata and MIOT Hospital, Chennai have submitted notice to opt out of CGHS. Regarding Ex-Servicemen Contributory Health Scheme (ECHS), as per the information provided by the Ministry of Defence, 174 Health Care Organizations (HCOs) have stopped giving cashless services to ECHS beneficiaries.

Under CGHS there is no pending bill pertaining to Government Hospitals. Clearance of pending bills of HCOs is a continuous process. During the Current Financial Year, HCOs’’ bills worth Rs. 1100 crore (approx.) have been paid and bills amounting to Rs. 797 crore (approx.) are received for payment. Under ECHS, Bills amounting to Rs. 75 crore (approx.) are also received for payment.

Under CGHS, following steps have been taken to ensure uninterrupted cashless services to the beneficiaries:

(i) Additional manpower has been mobilized to expedite settlement of hospital claims.

(ii) In June 2021, CGHS has shifted to settlement of bills in paperless mode on the IT Platform of National Health Authority which is an attached Office of Ministry of Health & Family Welfare.

As informed by Ministry of Defence, following steps have been taken for timely payment of bills to the hospitals empanelled under ECHS: –

(i) Provision of adequate budgetary support has been made.

(ii) Usages of IT solution for continuous monitoring for efficient processing of bills and timely payment.

(iii) Empanelment of additional HCOs as an alternative to those who have refused services.

Source: Lok Sabha