New Delhi: The Union health ministry has updated the guidelines for investigations and emergency treatments under the Central Government Health Scheme (CGHS). Referrals will also be streamlined under the revised rules. The ministry has developed standard operating procedures (SOPs) as part of the revised rules.
In case of an emergency, healthcare organisations can provide cashless treatment to eligible individuals without waiting for clearance from CGHS, according to the new rules. Only an emergency certificate is required. The issuer of this certificate will the the treating specialist at the CGHS empanelled hospital.
CGHS emergency rules revised
The beneficiary is required to upload the emergency certificate onto the BCA portal along with the claim. Further, referrals are not required for emergency treatments and investigations that are not listed under CGHS. The empanelled health facility can submit a request for enhancement or approval via the NHA portal for such emergencies, according to an office memorandum dated September 24, 2024.
What are revised CGHS referral rules?
For special consultations, memos issued by the CGHS medical Officer will have a 3-month validity, according to the new memorandum. The primary consultant can issue a memo for 2 additional specialities if they deem it fit. Beneficiaries are allowed up to a maximum of 6 consultations from the same expert for an acute illness within a 3-month window, according to the new rules.
Healthcare organisations are required to keep a scanned copy of the referral. These rules do not apply to referrals made by government specialists. Beneficiaries must carry follow-up consultations, tests and procedures at the same facility where they sought the primary consultation. Claims for each follow-up visit after the first referral must be logged separately on the official portal, according to the new rules.
Referral rules for benficiaries aged 70 years and above
CGHS beneficiaries aged 70 years and above will not be required to seek a referral for specialist consultation at empanelled hospitals. This also applies to tests and procedures. Unlisted tests and procedures must be approved by CGHS, according to the new rules which are aimed at simplifying the process for senior citizens above the specified age.
What is the revised CGHS rule for follow up in special cases?
Regarding follow-ups in special cases, the revised rules state that beneficiaries can undergo tests and receive consultations without any cap based on the primary referral for certain conditions. These include:
S. No.
Conditions covered
1
Post-cardiac surgery cases
2
Post-organ transplant cases
3
Post-neurosurgery cases
4
End-stage renal disease
5
Cancer treatment
6
Autoimmune disorders
7
Neurological disorders
This is a developing story. More to follow
The ministry of health and family welfare has updated the rules for CGHS to ensure ease of access to healthcare for government officials and pensioners. The new rules cover emergency treatment, consultations and investigations. Personal Finance Business News – Personal Finance News, Share Market News, BSE/NSE News, Stock Exchange News Today
