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
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
3) From DME, A.P., Hyd.,
Rc.No.20636/MA-F/05, dated.
4) From Secy. to State
Legislature, Hyd., Lr.No.570-A/OP-II/2005, dt.8-11-2005.
<<<>>>
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
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:
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.
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