GOVERNMENT OF ANDHRA PRADESH 

ABSTRACT

APIMA Rules, 1972 – Scrutiny of Medical Bills relating to MLAs, Ex-MLAs and their family members and officers, staff and retired persons and their dependents of Legislature Department by Director of Medical Education and follow of Nizam’s Institute of Medical Sciences /Sri Venkateswara Institute of Medical Sciences rates, if no Central Government Health Scheme rates are available – Amendment – Orders – Issued.

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HEALTH, MEDICAL AND FAMILY WELFARE (K1) DEPARTMENT

 

G.O.Ms.No.180                                                                                                                                             Dated the 11th May, 2006

                                          Read the following:

 

1)     G.O.Ms.No.74, HM&FW(K1) Deptt., dated.15-3-2005.

2)     From Legislature Deptt., U.O.No.63/MC/2005, dated 13-9-2005. 

3)     From DME, A.P., Hyd., Rc.No.20636/MA-F/05, dated. 9-11-2005

4)     From Secy. to State Legislature, Hyd., Lr.No.570-A/OP-II/2005, dt.8-11-2005.

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ORDER:

 

            In the G.O. first read above, Government have issued orders indicating detailed procedure on medical reimbursement of employees, M.L.A.s, Ex-M.L.A.s and their dependents etc.  Among other things, powers have been delegated therein to the Superintendents of Government Teaching Hospitals, District Hospitals and certain Medical officers for scrutiny of bills upto a value of Rs.25,000/-.  It was also ordered therein that for treatment obtained in Private Hospitals, Central Government Health Scheme package rates shall be followed. In respect of treatment obtained in Nizam’s Institute of Medical Sciences, Hyderabad and Sri Venkateswara Institute of Medical Sciences, Tirupati, their package rates shall be followed.

 

2.         In the reference second read above, the Secretary, Legislature Department has informed that during the meeting of Amenities committee held on 9-8-2005, it has been decided to entrust scrutiny powers to Director of Medical Education, Hyderabad for medical bills of M.L.As/Ex-M.L.As upto value of Rs.25,000/- also, as the Civil Surgeon Dispensary, Secretariat, Hyderabad is unable to scrutinise the bills, due to work load. When consulted, the Director of Medical Education has agreed to the proposal.

 

3.         In the letter, third read above, the Director of Medical Education has informed that Central Government Health Scheme (CGHS) rates are not prescribed for some diseases and conditions and different hospitals are charging different rates for the same processes.  He has requested for issue of clarification as how to scrutinize for the procedures which are not listed in the Central Government Health Scheme rates.

 

4.         Government after careful examination of the matter have decided to amend the orders issued in the G.O. first read above. Accordingly, Government hereby issue the following Amendments to G.O.Ms.No.74, H.M&F.W.(K1)department, dated:15-3-2005:-

 

AMENDMENTS

 

(1). In sub para (1) of para 9 of G.O.Ms.No.74, HM&FW(K1)Deptt., dated 15-3-2005, for the sentence; “If any rates which are not covered in the said procedure, the scrutiny authority is empowered to take final decision in the matter basing on the disease /nature of disease, necessity of treatment /medicine”, the following sentence shall be substituted, namely:-

 

“For the procedures which are not covered in the package rates prescribed in the Rate list of Central Government Health Scheme, when the treatment obtained in private hospitals, the package rates of Nizam’s Institute of Medical Sciences, Hyderabad for such procedure or Sri Venkateswara

(PTO)

 

 

 

                                                                                              

:: 2 ::

 

Institute of Medical Sciences, Tirupati shall be followed for scrutiny, certification of admissible amount and medical reimbursement purpose and it shall not exceed the maximum package rate prescribed in Central Government Health Scheme rates i.e. Rs.1,70,000/-”

 

(2).  After sub para (6) of para 9 of the said G.O., the following para shall be added, namely;

 

“6.A. In respect of claims of medical reimbursement relating to M.L.As, Ex-M.L.A.s and their family members, and officers, staff and retired persons, and their dependents of Legislature Department, irrespect of the value of the bill including below Rs.25,000/- (Rupees twenty five thousand only), the Director of Medical Education shall scrutinise the bills in terms of the rules. He shall make necessary arrangements for scrutiny of the bills accordingly and ensure that there will not be any delay in scrutiny.”

 

5.         The Director of Medical Education shall take necessary action in the matter accordingly.

 

6.         This order issues with the concurrence of Finance Department –vide their U.O.No.1376/103/A2/Exp-HM&FW-I/2006, dt.23-2-2006.

 

(BY ORDER AND IN THE NAME OF THE GOVERNOR OF ANDHRA PRADESH)

 

DR. I.V.SUBBA RAO

PRINCIPAL SECRETARY TO GOVERNMENT 

To

The Director of Medical Education, A.P. Hyderabad.

The Director of Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad.

The Director, Sri Venkateswara Institute of Medical Sciences, Tirupati.

The Secy., State Legislature, Assembly Buildings, Hyderabad.

The Legislature (MC/Pension) Department.

The Civil Surgeon Specialist, Civil Dispensary,

    A.P. Secretariat, Hyderabad.

All the Heads of Departments under control of

      Health, Medical & family Welfare Department.

All Superintends of Government Teaching Hospitals.

Copy to:  The General Administration (SR) Department

The Spl. Secy to C.M. / P.S. to Minister (Finance & Health)

P.S. to Prl. Secy. (W&P), Finance Deptt.,

Finance (Expr.HM&FW-I) Department.

 

// FORWARDED :: BY  ORDER //

 

SECTION OFFICER

Note:  This G.O. is available in the internet and can be accessed at the   

             address www.aponline.gov.in/gos