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Saturday, May 18, 2019

Meeting with the Secretary of Health Ministry




NATIONAL CO-ORDINATION COMMITTEE
OF PENSIONERS ASSOCIATIONS..

Website: nccpahq.blogspot.in.
E mail: nccpahq@gmail.com.

13.c Feroze Shah Road,
 New Delhi. 110 001
PRESIDENT:       COM.SHIV GOPAL MISHRA.(97176 47594)
SECy. GENERAL:          COM.K.K.N.KUTTY. (98110 483030)

Dated 17TH May, 2019.

Dear Comrades,

            The 47th meeting of the National Council JCM was held on 13th April, 2019.  This meeting was held after a lapse of about a decade.  As you are aware, the Staff Side of the JCM had to take the decision to organise a dharna programme at New Delhi to force upon convening such a meeting.  Since the Government indicated their willingness to convene the meeting of the National Council and the date was notified the proposed dharna programme was not held. 

            The agenda taken up for discussion at the meetings were pretty old and mostly pertaining to the 6th CPC issues.  The record of discussions that was prepared by the Staff Side is on the website of the National Council, JCM. Staff Side.  We are not reproducing the same for it has lost of its relevance to day.  If any comrade wishes to see the same, they may kindly visit the website of the National Council JCM. Staff Side. 

            In the said meeting, the issues related to the Health Ministry was discussed at length.  However, the staff side pointed out that the convention of having separately discussing the health-related issues must be followed.  Accordingly, the Secretary Health convened a meeting of the National Council, Standing Committee on 16th inst.   The undersigned attending the meeting in his capacity as the Standing Committee member.  After the meeting, a synopsis of the discussion was prepared by the Staff Side and the same is reproduced hereunder.  The issues discussed mostly pertains to the CGHS problems.  On the basis of the feed- back we have received from some of the affiliates, the NCCPA had prepared a listof items (fresh) and the same had been submitted to the Government for discussion in the meeting of 16th inst.   However, these items could not be taken up for discussion as the official side had complained of lack of sufficient time for them to study and respond.   It has now been agreed that another meeting will be convened soon to discuss those issues.  We send herewith the items we proposed to discuss at the meeting as and when it is convened.   We request our comrades to kindly go through these items and if any important issues have been omitted, we may be informed immediately so that the same can be included well before the next meeting is convened.   Incidentally we may point out that only from a few units, we received suggestions and views on problems connected with health care.  Many units chose not to respond to our communication in the matter. 

            We shall pursue these issues to reach a settlement.  With greetings,
Yours fraternally,

K.K.N. Kutty.
Secretary General.


A meeting with the Staff Side of the National Council JCM under the Chairmanship of Secretary, Ministry of Health & FW was held today at Nirman Bhawan, New Delhi. The Staff Side was represented by Comrades Shiva Gopal Mishra, Guman Singh, KKN Kutty, C. Srikumar, M. S. Raja and R.N. Parashar. The following agenda points were taken up for discussion and the decisions taken are given below for your information.
Item No
Agenda Points
Decision
1.
Non grant of 90% Medical Advance for all type of treatments by the Audit Authorities in the Ministry of Defence in violation of Ministry of Health and Family Welfare Letter No.      S.14025/18/2015-MS/EHSS dated 17.10.2016
It was Clearfield by the Official Side that 90% advance even in the case of other than package can be made to the employees as per Ministry of Health OM dated 17.10.2016. In case the Accounts Authorities of the MOD is not allowing the same, the MOD may be requested to refer the matter to Ministry of Health.

2.
Review of ward entitlement for Central Government Employees
It was agreed to reconsider the wage limit for Ward entitlement and also to streamline the same as per the 7th CPC pay matrix.

3.
Withdrawal of the condition imposed in Ministry of Health OM No. S.14011/1/73-M.C.,   dated 23rd August, 1973 with regard to diabetic treatment
The condition to produce certificate from DMO / Civil surgeon for continuing the treatment for diabetics etc has been removed and any Government Doctor can issue certificate in this regard.

4.
Review of package rate for Organ Transplantation
The actual cost of organ transplantation will be considered depending on merit of each individual case

5.
In-patient treatment in Hospitals without going through the AMA.
The Ministry of Health OM dated 2nd May 1953 will be re-circulated to all the Ministries which permits the in-patient treatment without AMA sanction

6.
Reimbursement of preventive Vaccination charges
This is a policy matter which Government will have to decide

7.
Emergency Treatments in CGHS recognized Hospitals.
At present the CGHS beneficiary can directly approach the recognized hospital with the CGHS Card without any referral memo. The proposal of the Staff Side to avoid hardship to the patient for subsequent dealings with the CGHS Wellness centre would be considered the concerned hospitals will be asked to get the approval of the concerned dispensary doctor.

8.
Reimbursement of Medical expenses not covered under the CGHS Package Rates.
Steps are being taken to revise the CGHS packages and at that time the inclusion of new procedure etc  would be considered.

9.
Issue of Medicines to CS(MA) beneficiaries availing inpatient treatment in CGHS recognized Hospitals.
Not agreed. CS(MA) beneficiaries has to get reimbursement of the Expenses

10.
Permission / Ex-post facto approval for elective treatment / investigation taken in non-empanelled Hospitals / Diagnostic Centers for CS(MA) beneficiaries at par with CGHS beneficiaries.
Not Agreed

11.
Treatment of dependents of the deceased Employees / Employees who have taken voluntary retirement / premature retirement / medical invalidation / compulsory retirement etc.

Provisional CGHS Card will be issued to the above category of employees based on the Last Pay Certificate

12.
Opening of CGHS Dispensaries in AGRA, Barrackpore (Kolkata) and Kochi
Government orders are already issued in this regard. As regards Kochi, Kozhikode and Kannur steps are taken to acquire accommodation for the wellness Centre. At Kochi the BSNL Quarters have been identify. Formalities to access the same is under way. The doctor shortage of Agra would be looked in to. At present Barrackpore wellness Centre is functioning as an extension counter. Depending upon its utility the demand for establishing the same as a permanent wellness centre would be considered.

13.
Central Government health Scheme. Empanelling of hospitals – streamlining the procedure to provide in-patient treatment to the beneficiaries.
More than Rs. 300 crores are due to the hospitals are being cleared and under way  to clear the same. steps are taken to streamline the payment procedure for the Hospitals

14.
DISPROPROPOTINATE  REVISION OF SUBSCRIPTION UNDER CGHS DUE TO REVISION OF PAY AND ALL0WANCES  OF  CENTRAL  GOVT. EMPLOYEES  ON ACCOUNT OF IMPLEMENTATION  SEVENTH PAY COMMISSION.
Not Agreed

15.
Direct consultation with Specialists in CGHS/Central Government/State GovernmentHospitals /Polyclinics. Continuation of the facility to those CGHS beneficiaries who wereeligible for direct consultation before revision of the Monetary Ceiling

The monetary ceiling is already removed

16.
Revision of monetary Ceiling for direct consultation with Specialists in CGHS/CentralGovernment/State Government Hospitals /Polyclinics in respect of Pensioners and Family Pensioners.

The monetary ceiling is already removed
17.
Plastic Cards
Settled

18.
Indication of Ward entitlement in plastic cards of pre-1-6-2009 Beneficiaries
Would be considered

19.
Grant of one time option to CGHS Beneficiaries to opt for ward entitlement as per their revised Pay in Pay Band.

Would be considered

20.
Provision of CGHS facility for life time to dependent disabled/mentally retarded children of Central Government Employees/Pensioners
Agreed to consider the demand in consultation with Department of Expenditure

21.
Extension of CGHS facilities to retired BSNL employees - follow up action by the Ministry of Health and family Welfare & fixation of rates of contribution & ward entitlement.
Settled


The remaining twelve fresh agenda points would be discussed later. The Health Ministry will fix the date for the said meeting.

The issue of inadequacy of CGHS empanelled hospitals at Mumbai was seriouslydiscussed in the meeting. After discussion the official side agreed to re visit the issue considering the difficulties being faced by the Central Government Employees posted in Mumbai it was also agreed that the demand of the Staff Side for establishing a Central Government Hospital at Mumbai  would be considered again and the proposal of the Staff Side to locate the said hospital at Antop Hills was favourably responded.

With Greetings,
Yours Comradely,


(Shiva Gopal Mishra)

KKN KUTTY
Member,standing Committee.

To
The Secretary,
Staff Side,JCN.NationalCoubcil,
New Delhi.

Dated: 9th May, 2019
Dear Comrade,

            I am sending the following agenda items for discussion with the Secretary Health.  This may kindly be forwarded to him.  This is prepared on the basis of the memorandum and letters, the staff side office has received.   The items are not exhaustive.  However, all important issues have been incorporated. 
            Thanking you,
Yours fraternally, 
KKN Kutty

Agenda Item No. 1

Empanelling Hospitals

The Government has recognized Private Hospitals for in-patient treatment of CGHS beneficiaries. The list of such hospitals in each cities is given on  the website of the CGHS. We hope that the list has been periodically getting updated.   The following are some of the oft repeated complaints over the functioning of the CGHS empanelled hospitals.
i.)                  Inadequacy of the Number of hospitals.
ii.)                 Non-permission for cashless treatment by the hospital due to the outstanding Bills for pensioners.
iii.)               Non-permission of consultation with specialists of Private recognized hospitals by the beneficiary without reference from the CGHS
iv.)              Lack of basic infrastructure and facilities in  some of these hospitals

In view of these and other complaints,  we may suggest the following for the consideration of the Government.

1.       The No. of hospitals to be recognized in each city must have some relationship with the No. of Beneficiaries in that city.
2.       The Ministry must stipulate  certainbasic amenities in hospital which are proposed to be recogfnised.  Viz.  sufficient  number of doctors and other , Para medical Staff, Beds, Patient Rooms, pathological laboratories, icu, iccu,  etc as a pre requisite for empanelment.
3.       Cashless treatment for pensioners has to be a pre-condition to be insisted upon.
4.       Government must provide a system generate for payment of bill to hospitals within six x months failing which government must pay lowest at a stipulated rate. Responsibility for the delay in payment and consequent payment of interest may be accounted for and the person responsible for the delay be penalised..
5.       The beneficiaries must have the right conferred upon them seek consultation with a specialist in a recognized hospitalas  a matter of course  and in case of surgery or treatment for follow up for a period not less than 3 years.
6.       For each city, the No. of such recognized hospitals for General treatment must not be less than 5 and for specialized treatment for chronic  diseases, not less than three.
7.       The Government must prepare a list of hospitals which have applied for empanelment and their cases taken up for recognition as and when they comply with the stipulated requirement.
8.       Continuous empanelment introduced by the Government has the inbuilt condition that the concerned hospital can opt out of CGHS  as and when they like.  This has not worked properly and therefore may be reviewed.
9.       The Government has been stipulating that all private hospitals which enjoys certain tax benefits or land allotment  must provide free treatment to poor as part of social obligations.  The Government shall not have any difficulty in stipulating that these hospitals should also provide treatment to Government employees on payment of charges restricted to the governmental stipulations.  We, therefore, that such a stipulation if made will go a long way in ensuring health care to the government employees at reasonable rates.         
Item No. 2.
Emergency Dispensaries
The dispensary timings are so conceived to ensure the optimum utilization of the available man-power. This however, creates a situation whereby at certain point of time, no dispensary will be available even to help a patient  in emergency. This causes problem and therefore we suggest to have one dispensary in each city earmarked as emergency dispensary functioning 24 x 7 and sufficient manpower is provided to that dispensary.
Item No. 3
Diagnosis centers/laboratories .
Doctors depend on the report of tests conducted by the diagnoses centre/ laborites for diagnosis and to prescribe medicine. it is better that all emergency dispensaries, which may be opened in all CGHS cities  have also an attached diagnosis centre/Labs. If it is not feasible to do so, the Government many undertake to recognize reputed private pathological centres and the bills paid to the laboratories directly by the Government. These recognised centres may send the report of the test directly to the concerned CGHS doctors, aso that the patient need not visit the centres twice for undergoing the test and obtaining the report thereof.
Item No.4
Government has recognized various private hospitals in non CGHS areas. The employees and others who work in non CGHS areas and are covered by CCS (MA) Rules are entitled to get in-patient treatment at these hospitals. This has helped the employees to get quick and better  treatment and consequently unburdenthe Government run hospitals. The CGEs who are CGHS beneficiaries are often transferred to non CGHS areas. They are per force as per the present regulation to seek in-patent treatment in those hospital recognized by Government in CGHS areas. It  isour request that those  hospitals which are recognized for the purpose of reimbursement under CCS (MA) Rules at non CGHS centres may also be recognized for treatment for CGHS beneficiaries, whenever required.
Item No. 5
Dispensing  branded Medicines
Themedicines  prescribed by Specialists  often not available in the dispensary. The autyhroised chemists are approached through indent and they take a few days tpo deliver the prescribed medicines. More often they supply substitute medicines.  It is not our points that the substitutes supplied by the chemist mightalways  be of any lower quality. Howeverthe patient being ignorant of the component and ingredients of the medicine is psychologically impacted.  The authorised chemists must be instructed that the prescribed branded medicine must be dispensed with and they should not substitute it with another brand medicine..
Item No.6
Reconsidering the norms of appointment of Specialists in major metro cities:
The existing norms for appointment of Specialists in major metro cities are totally inadequate to treat the number of patients in CGHS. For example in Chennai City with more than 1,00,000 CGHS beneficiaries, only one Eye Specialist Doctor is in place. This Specialist is being rotated between two Centers at K.K.Nagar and Annanagar Wellness Centers during the week. The  eye patients are more in number and the  availability of Specialist only on selective days of the week is causing extreme hardship to senior citizens especially octogenarians and septuagenarians. It is therefore requested that the norms may be so amended as number of specialists in a particular city has some relationship to the No. of registered beneficiaries in that city.
Item No. 7
Medicines:
Currently in almost all CGHS centers, the patients are not supplied with all the required medicines immediately after consulting the Doctors. Even routine medicines like the tablets for Blood Pressure and Diabetes are not available on the first visit of the patients. Local Purchase is ordered and the patients are asked to come back again after three days for those medicines. This is causing unnecessary travel strain on the aged patients besides the patients remain medicine less for some days. This condition is prevalent in many States like Tamilnadu, Andhra and Telangana etc. Therefore we propose that suitable arrangements as in the past should be made to stock sufficient medicines for supply to the patients on their first visit to the CGHS Dispensaries. We also would like to point out that the retired MLAs and M.Ps for whom the medicines to be purchased on local purchase (LP) are at present sent by Couriers by post. They need not come back again the next day or later when the LP medicines are ready with the Wellness Centre. Similar facility may be extended to the Pensioners who are CGHS beneficiaries but living in far flung non-CGHS areas so that they get the medicines of local purchase by speed post.

Item No.8
Recognizing referral hospitals and Clinics in all Districts:
CGHS is now opened for all P&T Pensioners living in non-CGHs areas also. P&T Pensioners are known to be present and living in all districts of the country. We can understand that CGHS wellness Centers cannot be opened in all Districts. But CGHs has a panel of private referral hospitals. Similar is the case with the Clinics and labs for pathological tests for the beneficiaries. The condition is that these hospitals and Clinics should agree to charge at the CGHS rates. We propose that at least one referral hospital and one or two clinics in each district  should be recognized or approved on certain conditions. This will go a long way to help the Pensioners to take treatment without straining themselves to undertake a long journey to reach out the CGHS city for any treatment.
Item No.9
Lump sum payment for life termCGHS benefit to be related to the pay drawn at the time of retirmenet in the case of pensioners.
P&T Pensioners living in non-CGHS areas were not allowed to join CGHS due to the earlier.. Now after the recommendations of the 7th CPC and due to Court intervention at Kerala, the Health Ministry has taken back the earlier prohibition.All the P&T Pensioners are not permitted to join CGHS. But the question is they are to remit the subscription at the rate finalized after 7th CPC. The enhanced rate of subscription is understandable for the serving employees and the pensioners retiring now after getting higher salaries of 7th CPC. But fixing the same 7th CPC rates for the past Pensioners especially those who had retired long back is a bit unjustified. We propose that the past pensioners as a one-time measure may be permitted to join CGHS on remittance of lump-sum payment at the rates prevailing in the month in which the beneficiary retired. .

Item No.10.
Other miscellaneous issues:
(a)    The CGHS doctors may be asked to honour the prescription of the specialist doctors of recognised hospitals;
(b)   Explore whether  separate queue can be provided for pensioners at dispensaries.
(c)    Facility of lift may be provided in all dispensaries which are housed in multi-storey buildings.
(d)   Introduce the medical insurance scheme for the Pensioners and working employees residing in non CGHS areas, onthe lines of the scheme enunciated by the Government of Kerala.
(e)   The Additional Directors may be instructed to hold periodical meetings (say once in three months)  with the representatives of CGHS beneficiaries to resolve the local problems.
(f)     To revise the package rates immediately  as the prices of certain medicines and procedure charges have increased enormously.










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