No. 24(9)/03/US(WE)/D(Res)

Government of India
Ministry of Defence

New Delhi, the 16th June'2004

To,

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

Subject: Procedure for empanelment of Hospitals, Nursing Homes and Diagnostic Centres under Ex-servicemen Contributory Health Scheme

Sir,

With reference to Govt. of India, Ministry of Defence letter No. 22(1)/01/US(WE)/D(Res) dated 30th Dec'2002, I am directed to convey the sanction of the Government that the 'Procedure for Empanelment of Hospitals, Nursing Homes and Diagnostic Centers as spelt out in Appendix A to this letter will be followed by the ECHS with immediate effect.

2. The empanelment procedure will be reviewed after one year.

3. This issues with the concurrence of Ministry of Defence (Finance) vide their U.O No.581/PD/04 dated 15-06-2004

 

 

Yours faithfully,

 

 

Sd/--

 

(V.K. JAIN)

 

Under Secretary to the Govt. of India

 

Appendix A

PROCEDURE FOR EMPANELMENT OF HOSPITALS, NURSING HOMES AND DIAGNOSTIC CENTERS FOR EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME (ECHS)

1. The procedure for Empanelment of Hospitals/Nursing Homes and Diagnostic Centers by the ECHS as laid in succeeding paragraphs will be followed for Ex-Servicemen Contributory Health Scheme (ECHS).

2. Advertisements. An advertisement will be placed in leading newspapers (Regional and English Language) inviting applications for empanelment of Hospitals/Nursing Homes and Diagnostic Centers. The advertisements will be placed by Central Organisation, ECHS/ HQs Sub Area/Area for all stations under their jurisdiction depending upon the requirement.

3. Application for Empanelment. A standard Application form for Empanelment of Medical facilities for ECHS will be made available by the ECHS on a nominal payment (as laid down by Central Organisation, ECHS) at the Station Headquarters. The application form duly completed as per format, will be submitted by the Hospital/Diagnostic centre and Nursing Home to the Station Headquarters under whose jurisdiction the station is located.

4. Board of Officers. A Board of Officers constituted as under, will be convened to recommend for empanelment of the Hospitals, Diagnostic Centers etc: -

(a) Chairman - Station Commander.

(b) Members -

(i) Senior Executive Medical Officer (SEMO) or equivalent in Navy and Air Force for the Station.
(ii) One specialist in either Medicine or Surgery.
(iii) One specialist from applicable Speciality, if required (to be nominated by Officer Commanding Military Hospital / Deputy Director Medical Services (DDMS) Area/Command).

5. Evaluation Procedure. The Board of Officers will visit the facility proposed for empanelment to carry out assessment and verify the facts made available by the Hospital/Nursing Homes and Diagnostic centers. The Board of Officers will ensure that the rates quoted by the Hospital/Nursing Homes and Diagnostic centers are within the approved CGHS rates. The Board of Officers will recommend empanelment based on the following criteria (checklist attached as Annexure): -

(a) Reputation.

i) Historical Background and performance history of the Institution.
ii) Accreditation if any
iii) Empanelling by Govt Medicare schemes - CGHS, Railways, Armed Forces, etc.
iv) Empanelling by other Medicare schemes - AGIF, AFGIF, Public Sector Undertakings, Insurance companies etc.

(b) Accessibility - Location & distance from ECHS clinic, accessibility to public transport and accessibility from surrounding areas.

(c) Professional Services Available.

(i) Availability of different services like Outpatient services, Inpatient services, Intensive Care unit, Emergency, Operation Theatre, Diagnostic Services and Super Specialists services with details.

(ii) Bed availability category wise - The details of number of beds and their distribution will be listed. Nursing ratio will also be taken in account.

(iii) Workload in different departments- The total workload in all specialties and the clinical procedures will be attached for evaluation of empanelment or otherwise.

(iv) Detailed lists of faculty (permanent/visiting) with their qualifications. A list of doctors along with professional qualifications and terms of engagement (permanent/visiting faculty) will be given.

(d) Rates Charged

(i) The Hospital, Diagnostic Centre and Nursing Home will include the actual charges (standard rates for semi private wards) for private patients, and rates that would be charged from ECHS beneficiaries in the application form submitted to the Board. It will be ensured that rates to be charged for ESM and their families including OPD, Indoor and Lab investigations do not exceed CGHS rates or the actual whichever is lower.

(ii) The Hospital/ Nursing Home/ Diagnostic Centre should also agree to accept payments of bills from ECHS within a period of 60 days to 90 days.

(e) Certificate/Undertaking by the authorized head of institution certifying that the information provided is true and correct and the Hospital, Nursing Home and Diagnostic Centre will abide by the approved rates for ECHS beneficiaries.

(f) Recognition - The Board of Officers will recommend the recognition for type of service as follows: -

(i) Super Speciality services - type and details.
(ii) All services - Indoor and Outdoor - Specialities to be mentioned.
(iii) Outpatient services - General/ Speciality (Type).
(iv) Inpatient services- Speciality (Type).
(v) Diagnostic -Type and details.

6. Processing of Board Proceedings. The Board Proceedings will be forwarded through the normal chain of command to respective Area Headquarters/ Independent Sub Area Headquarters for their recommendations and onward submission to Ministry of Defence through Central Organisation, ECHS. The scrutinized proposals for empanelling short-listed hospitals, etc. would be placed before an Empowered Committee under the Chairmanship of Addl. Secretary in MOD in a proper and self-explanatory format for decision and approval. The composition of the Committee will be as under:

i)

Additional Secretary(M)

 Chairperson

ii)

JS(ESW), MOD

 Member

iii)

JS(E)/Med

 Member

iv)

Addl FA, Def(Fin)

 Member

v)

Rep of DGAFMS

 Member

vi)

DGD C&W or his Secretary nominated representative

 Member

Period and Terms of Agreement

7. On receipt of approval of the Empowered Committee of MOD, Memorandum of Agreement (MOA) as per standard ECHS format will be signed by the Station Commander with the concerned Hospitals/ Nursing Homes and Diagnostic Centers. The period of empanelment will be valid for two years or until further orders whichever is earlier. If the services of the Hospitals, Nursing Homes and Diagnostic centers are found to be satisfactory, extension of empanelment may be done on mutual agreement, with the approval of the sanctioning authority.

8. In case of unsatisfactory performance, unethical practices or medical negligence by any empanelled Hospital, Nursing home and Diagnostic Centre, a show cause notice will be issued to concerned empanelled facility by the Station Commander. Agreement/contract of empanelment will be terminated if charges are established, on approval from Ministry of Defence i.e. the appointing authority.

Payment Procedure

9. Payments will be made to Hospitals/Nursing Homes and Diagnostic Centers directly by the concerned Station Headquarters on approval by the Competent Financial Authority (CFA). Such payments shall be made by cheque and shall be post audited. The detailed procedures for payment to empanelled facilities have been issued vide MOD's letter No. 24(8)/03/US(WE)/D(Res) dated 19th December 2003.

Settlement of Disputes

10. In case any dispute arises between the Station Commander and any empanelled Hospital, Diagnostic Centre or Nursing Home, the empanelled facility concerned has the right to appeal to one superior level. The decision taken by the superior authority will be final and binding to both parties. Arbitration for any dispute will be conducted in terms of the Memoranda of Agreement signed between empanelled facility and Station Commander.

Derecognition/Disempanelment

11. If any empanelled Hospital, Nursing Home or Diagnostic Center is detected to be indulging in malpractice, unethical practice or medical negligence, the matter will be got investigated by the Station Commander.

12. On receiving information of derecognition of Hospitals, Nursing Homes and Diagnostic Centers by the CGHS, Railways, DGAFMS or other Govt Organizations, the matter will be got investigated by the Station Commander.

13. On receiving information in both cases as listed out in paragraphs 11 and 12 above, the empanelled facility will be given an opportunity to show cause before a decision of disempanelment is taken.

14. Authority for Disempanelment The Ministry of Defence which accords approval for empanelment will be the authority for disempanelment.

Review of Procedure

15. The above mentioned procedure will be reviewed by the Ministry of Defence after a period of one year.