CGHS officials get financial powers to cut claim delays

NEW DELHI: Lakhs of central govt health scheme (CGHS) beneficiaries could soon spend less time waiting for approval of costly medical claims, surgeries and specialised treatment, with the Union health ministry increasing the financial powers of CGHS officials to clear more cases without escalating them further. The revised delegation of powers, notified Thursday, is expected to speed up reimbursement of hospital bills and approvals for expensive procedures by allowing more decisions to be taken by CGHS authorities in cities instead of at higher levels. Additional directors heading CGHS cities and zones can now approve reimbursement claims of up to Rs 15 lakh, more than double the earlier ceiling of Rs 7 lakh. The director, CGHS can sanction claims up to Rs 25 lakh, while the additional secretary and director general, CGHS can approve claims up to Rs 50 lakh, twice the previous limit. Only claims exceeding Rs 50 lakh will require approval from the health ministry with the concurrence of the integrated finance division. The financial limits for unlisted investigations, implants and specialised procedures, where no CGHS package rate exists, have also been doubled. Additional directors can now approve such cases up to Rs 2 lakh, directors up to Rs 5 lakh and the additional secretary and DG up to Rs 10 lakh. The order also allows additional directors to approve eligible treatment and diagnostic tests taken at nonempanelled hospitals, even after the treatment has been completed where prior permission was not obtained. They can also regularise certain procedural lapses, such as treatment taken without prior approval at empanelled hospitals, provided the claim is otherwise admissible under CGHS rules. Officials said the revised delegation is intended to streamline procedures, reduce avoidable references and ensure quicker disposal of claims and treatment approvals. The ministry clarified that the enhanced powers do not relax CGHS rules. Reimbursements will continue to be governed by CGHS package rates, medical necessity, budget availability and audit requirementsGet the latest India news and live updates. Download the TOI App.