MADHYA PRADESH CIVIL SERVICES (MEDICAL ATTENDANCE) RULES, 2022

 

PREAMBLE

In exercise of powers conferred by the proviso to Article 309 of the Constitution of India and all powers enabling it in this behalf, the Governor of Madhya Pradesh, hereby, makes the following rules for regulating the medical attendance and treatment of Government employees and their families, namely :-

Rule - 1. Short title, applicability and commencement.

(1)     These rules may be called the Madhya Pradesh Civil Services (Medical Attendance) Rules, 2022.

(2)     These rules shall apply to -

(a)      Government employees while they are on duty or on deputation or leave or on training or under suspension within Madhya Pradesh;

(b)      Government employees working on contract basis;

(c)      Home-guards while under training or on duty;

(d)      Full time employees paid from contingencies;

(e)      Member of Work-charged establishments employed continuously on monthly wages.

(3)     These rules may also be adopted by Societies/Nigam/Mandal etc. of the State for medical reimbursement for their employees.

(4)     These rules shall not apply to -

(a)      Retired Government Employees;

(b)      Part time Government Employees;

(c)      Honorary workers working under the State Government.

(5)     They shall come into force from the date of publication in the Madhya Pradesh Gazette.

Rule - 2. Definitions.

In these rules, unless the context otherwise requires, -

(a)      "Authorized Doctor" means the prescribing doctor of any hospital maintained by the State Government/Central Government/Public Sector Undertaking/Local Government in the State. In case of emergency or in case of medical treatment availed by a Government employee during tour/training/leave, in a non-empaneled hospital, authorized doctor shall mean the doctor prescribing treatment;

(b)      "CGHS" means Central Government Health Scheme;

(c)      "Civil Surgeon cum Chief Hospital Superintendent" means the authority in-charge of a District Hospital of Government of MP;

(d)      "Controlling Officer" means the officer of the Department having administrative control for the Government employee;

(e)      "Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) of such a nature that the absence of immediate medical attention could reasonably be expected to result in -

(i)       Placing the health of the individual or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy; or

(ii)      Serious impairment to bodily functions; or

(iii)     Serious dysfunction of any organ or part of a body;

(iv)    Life threatening complications;

(v)      Fatality;

(f)       "Family" means-

(i)       The spouse of a Government employee;

(ii)      The parents, legitimate children adopted legally and step children of such Government employee residing with and wholly dependent on that Government employee;

(iii)     Members of Government employee's family who are kept by the Government employee concerned at a place other than his own residence for education or treatment for the sake of convenience to himself, shall be deemed to be residing with him;

(iv)    Divorced daughter who is wholly dependent on the Government employee;

(v)      Parents of married female Government employees who are wholly dependent on her and do not have any income from other sources, who generally reside with the married female Government employee throughout the year then the married female Government employee will be eligible for reimbursement of treatment claims of her parents (father/mother) under these Rules. To avail such facility the married female Government employee shall produce a declaration that "Parents of the manned female Government employee are wholly dependent on her and residing with her and the parents do not have income from any other sources or any other support."

(vi)    Retired/Pensionary Parents having a total annual income of Rs. 3 lakhs including pension and all other sources shall be considered dependent on the Government employee;.

(vii)   Where both husband and wife are Government employees, medical reimbursement of expense incurred on treatment of dependents shall be claimed by only one of them;

Where both husband and wife are Government employees and one of them is in Central Government service or any other semi-Government/Autonomous Institution such as - University/Board/Corporation or Private Institutions, where they have facility of reimbursement of medical expenditure, they shall produce a Joint declaration on a plain paper stating the place where the husband/wife is in-service and who is eligible for reimbursement of medical claims under that situation. Claims shall be submitted by the individual availing the treatment and in case of dependent child, the medical reimbursement claim may be submitted by husband or any one of the both.

(viii)  In situations where there are two or more living children, if there is birth of another child then, the children so born shall not be eligible for benefits under these rules. However, in case of children born during second labor as a consequence of multiple pregnancy, then the children so born shall be eligible for benefits of medical reimbursement.

(g)      "Empaneled Hospital" means, private hospital enlisted by the Health and Family Welfare/Medical Education Departments of the State Government for treatment of Government employees and their dependent family members;

(h)     "Form" means, a form appended to these rules.

(i)       "Government Employee" means a person as defined under sub-rule (2) of rule 1;

(j)       "Government Hospital" means a hospital maintained by the State Government/Central Government/Public Sector Undertaking/Local Government of the State.

(k)      "Hospital" means Government hospital or such private hospital as may be recognized as hospital for the purposes of these rules and includes a maternity home;

(l)       "Medical Officer" means a Registered Medical Practitioner in Govt./Private Hospital and includes a member of the teaching staff of Medical College who treats patients in the hospital attached to such college;

(m)    "Package Rates" means the CGHS rates laid down for Bhopal city.

(n)     "Treatment" means the use of all medical/surgical facilities (including dentistry) available at the hospital in which the Government employee is treated and includes -

(i)       The employment of such pathological, bacteriological, radiological or other methods as are considered and certified in writing as necessary by the authorized doctor;

(ii)      The supply of such medicines, vaccines, sera or other therapeutic substances as are ordinarily available in the hospital;

(iii)     Such nursing as is ordinarily provided to in-patients by the hospitals;

(iv)    Transfusion of Blood and Blood components;

(v)      Phototherapy or/and Infrared therapy;

(vi)    Treatment during pregnancy (ante-natal, intra-natal and postnatal treatment including treatment for abortion);

(vii)   Pre-conception treatment for Infertility for Government employee only.

Rule - 3. Outpatient Consultation.

A Government employee shall be entitled to free outpatient consultation by an authorized doctor in a Government Hospital. The authorized doctor shall not be entitled to charge any consultation fee and if it is charged or paid, the same shall not be reimbursable.

Rule - 4. Treatment of Government employee suffering from Mental disease.

A Government employee suffering from a mental disease, shall be entitled to medical attendance, treatment, accommodation and diet, free of charge in a Government Mental Hospital/Wards for mental patients in the District Hospitals/Government Medical Colleges of the State, if the nature of his illness mandates admission as established by a Psychiatrist of a Government Mental Hospital/District Hospital/Government Medical College of the State.

Rule - 5. Treatment in case of Emergency Medical Condition.

A Government employee in case of emergency medical condition can avail treatment in any hospital and shall pay in the first instance bills, if any, preferred by the hospital authorities on account of medical attendance, treatment, room rent or diet or on any other account and may. thereafter prefer claim for reimbursement as provided in sub-rule (4) and (5) of Rule 11. The Government employee will have to necessarily submit a certificate in Form I along with the claim for reimbursement in such cases.

Rule - 6. Reimbursement of Expenditure incurred for Out-PatientTreatment.

Expenditure incurred on treatment prescribed by the authorized doctor for out-patient treatment in Government Hospital will be reimbursed on submission in Form-II provided that:

(1)     If a Government employee submits medical reimbursement bills in respect of treatment of himself or any dependent member of his family in a Government Hospital, as an outdoor patient not exceeding Rs. 2000/- (Rupees two thousand only) per month for four times in a year or continuously for three months but not exceeding Rs. 8000/- (Rupees eight thousand only) in a year and the bills shall be approved by the Controlling Officer after due examination.

(2)     If a Government employee submits medical reimbursement bills in respect of treatment of himself or any dependent member of his family in a Government Hospital as an out-door patient exceeding Rs. 8000/- (Rupees eight thousand only) but less than Rs. 20000/-(Rupees twenty thousand only) in a financial year, the Controlling Officer shall forward the same to the Civil Surgeon cum Chief Hospital Superintendent of the district for examination and favorable recommendation in consultation with the District Medical Board as prescribed below: -

(a)      Civil Surgeon cum Chief Hospital Superintendent;

(b)      Medicine specialist/PGMO Medicine;

(c)      Surgery specialist/PGMO Surgery;

(d)      Any other specialist/PGMO (as mandated in the claim pertaining to a specific disease);

In case of a treatment by any Indian System of Medicines or Homeopathy, the bills shall be forwarded to the Divisional Officer, Ayurveda or District Ayurveda Officer in charge of the district. All such bills shall be passed by the Controlling Officer only on the favorable recommendation of Divisional Officer, Ayurveda or District Ayurveda Officer in charge, as the case may be.

(3)     Medical reimbursement claims in respect of treatment of himself including any dependent member of his family in a Government Hospital as an out-door patient exceeding Rs. 20000/- (Rupees twenty thousand only) in a financial year, shall not be approved.

The above provisions shall not be applicable in respect of reimbursement of bills relating to-

(a)      In-door patients; and

(b)      Patients suffering from such disease in respect of which Civil Surgeon cum Chief Hospital Superintendent concerned has issued a certificate in the prescribed Form-III, to the effect that the treatment for the disease is required or likely to continue for prolonged period.

However, such certificate shall not be issued for a period exceeding one year at a time but may be renewed from time to time for such period as may be necessary not exceeding one year at a time and the Civil Surgeon cum Chief Hospital Superintendent shall maintain a register containing particulars of such certificate issued by him in such manner as may be prescribed by the Government. For such illnesses, the limit of Rs. 20000/- will not apply.

Rule - 7. Reimbursement of Expenditure incurred on Charge of Ambulance and Air Ambulance.

Expenditure incurred by a Government employee or his family on account of charges for use of an ambulance or any conveyance shall not be reimbursable;

Use of air ambulance, for treatment of Government employee or his family member in empaneled hospital outside the State, only in case of emergency medical condition, may be approved by Director, Medical Education and Director, Health Services;

Post-facto approval for reimbursement of claims for use of air ambulance, shall be examined by Director, Medical Education and Director, Health Services, for establishing the urgency of shifting with regards to the emergency medical condition of the patient.

Rule - 8. Expenditure incurred by a differently-abled Government employee.

Expenditure incurred by a differently-abled Government employee on account of charges incurred for caliper, prosthesis, shoes for deformity, handicap bandages, neck collars or other necessary equipment shall be reimbursed, for the first purchase only.

Rule - 9. Package rates for Medical Reimbursement for In-Patient treatment.

Notwithstanding anything contrary to these rules ;

(1)     All claims of medical reimbursement for in-patient treatment submitted in Form-IV, shall be reimbursed within the ceiling of CGHS package rates for the city of Bhopal, as prescribed from time to time.

(2)     Claims for medical reimbursement of treatment cost, exceeding stipulated package shall be reimbursed within the ceiling prescribed in sub-rule (1) of Rule 9.

(3)     In case of in-patient treatment in emergency medical condition within or outside the State, where package rate under CGHS, Bhopal city is not available, claims amounting to less than Rupees 5 lacs, shall be approved by the Controlling Officer on recommendation of Divisional Committee as prescribed below: -

(4)     In case of in-patient treatment in emergency medical condition within or outside the State, where package rate under CGHS, Bhopal city is not available, claims amounting to more than Rupees 5 lacs but less than Rupees 20 lacs, shall be approved by the Controlling Officer on recommendation of State Level Committee as prescribed below: -

Rule - 10. Approval of advance for In-Patient Treatment.

(1)     A Government employee may claim up to 80% of estimated medical expenditure as advance, for treatment of himself or any dependent member of his family.

(2)     A Government employee may seek approval of advance for treatment in hospitals maintained by the State/Central Government/PSU/Local Government of the State, from his Controlling Officer based on the recommendation of the Superintendent of the treating hospital regarding the estimated medical expenditure.

(3)     A Government employee may seek approval of advance for treatment in private hospitals empaneled by the State Government for specific diseases within the State, from his Controlling Officer based on the recommendation of the Civil Surgeon cum Chief Hospital Superintendent regarding the estimated medical expenditure.

(4)     A Government employee may seek approval of advance for treatment in private hospitals empaneled by the State Government for specific diseases outside the State, from his Controlling Officer based on the recommendation of the Dean of the nearest Government Medical College regarding the estimated medical expenditure.

(5)     No claims of advance for treatment in non-empaneled hospitals within or outside the State shall be approved.

Rule - 11. Procedure for Reimbursement of expenditure incurred for Inpatient Treatment.

Expenditure incurred for in-patient treatment of Government employee or his family within stipulated packages as provided in Rule-9 shall be reimbursed as prescribed below:-

(1)     In hospital(s) maintained by State Government/Central Government/Public Sector Undertakings/Local Government Within State a Government employee or any dependent member of his family may avail in-patient treatment without any prior referral. All such claims for medical reimbursement regarding the expenditure incurred on treatment, shall be approved by the Controlling Officer on the recommendation of the Civil Surgeon cum Chief Hospital Superintendent.

(2)     In Private hospitals empaneled by the State Government for specific diseases, within the State, a Government employee or any dependent member of his family may avail in-patient treatment for specific diseases as prescribed from time-to-time, without any prior referral.

All such claims for medical reimbursement regarding expenditure incurred on treatment shall be approved by the Controlling Officer of the claimant on recommendation of a Regional Committee, as prescribed below:

(1)     Regional Director Health Services - Chairperson.

(2)     Civil Surgeon cum Chief Hospital Superintendent of the divisional headquarter district - Member Secretary.

(3)     Divisional Joint Director (Treasury and Accounts) - Member.

(3)     In Private hospitals empaneled by the State Government Outside the State, a Government employee or any dependent member of his family may avail in-patient treatment for specific diseases as prescribed from time-to-time, provided a prior referral permission is obtained from the Dean of the nearest Government Medical College in prescribed Form-V, before availing such in-patient treatment.

The Controlling Officer of the claimant shall approve such claim, based on the recommendation of the Divisional Committee, as prescribed in sub-rule (3) of Rule 9.

(4)     In non-empaneled hospitals, within the State (Only in case of Emergency Medical Conditions) Referral for in-patient treatment shall not be permitted.

All such claims for medical reimbursement on expenditures incurred on account of an emergency medical condition necessitating in-patient treatment in non-empaneled hospital, within the State, may be submitted by the Government employee to the Controlling Officer for approval. The claim shall be decided as per the recommendation of the Divisional Committee, as prescribed in sub-rule (3) of Rule 9.

(5)     In outside the State non-empaneled hospitals (Only in case of Emergency Medical Conditions) Referral for in-patient treatment shall not be permitted.

All such claims for medical reimbursement on expenditures incurred on account of emergency medical condition necessitating in-patient treatment in a non-empaneled hospital outside the State. may be submitted by the Government employee to the Controlling Officer for approval. The claim shall be decided as per the recommendation of the State Level Committee, as prescribed in sub-rule (4) of Rule 9.

Rule - 12. Approval processes of empanelment of Private Hospitals.

(1)     Empanelment of the Private Hospitals, within the State shall be decided by a committee as prescribed below:

The approving authority for empanelment of Private hospital within the State shall be the Department of Public Health and Family Welfare.

(2)     Empanelment of the Private Hospitals, outside the State shall be decided by a committee as prescribed below:

The approving authority for empanelment of Private hospitals, out of State shall be the Department of Medical Education.

Rule - 13. Application for reimbursement.

(1)     Application for reimbursement for Out-Patient treatment and Inpatient treatment shall be submitted to the authority within six months from the date on which the expenditure is incurred, in Form II and IV respectively.

(2)     In case of medicines not included in the Essential Drug List or for medicines included in the Essential Drug List but are unavailable in the Government hospital, every application made for Out-Patient treatment under sub-rule (1), shall be accompanied by an "Essentiality Certificate" in Form VI duly signed by the authorized doctor annexing receipts and cash memos in respect of all payments made on account of charges incurred on drugs and diagnostics, duly counter signed by the Civil Surgeon cum Chief Hospital Superintendent;

If the authorized Doctor has been transferred or is on long leave, then the doctor working in his place shall be eligible for signing the invoices/cash memorandums.

The cash memorandum submitted in support of the claim for reimbursement of cost of special medicines purchased from the market under the Medical Attendance Rules, need not however, be stamped or bear the supplier's acknowledgement.

The Goods and Services Tax charged on the cost of medicine is part of the cost of medicines concerned and reimbursement thereof is admissible.

Rule - 14. Maintenance of Dairy.

The Authorized Doctor shall in respect of such Government employee maintain in the form of a diary or memorandum the details, including place and the date of treatment or any examination conducted by him which shall form the basis for the certificate to be given by him in Form II.

Rule - 15. Disposition of Claims.

(1)     The claim of a Government employee for reimbursement of medical expenses under these rules shall be disposed of by the Drawing and Disbursing Officer concerned.

(2)     All bills for medical expenses, shall be countersigned by the controlling authorities who are empowered to countersign travelling allowance bills of the Government employee concerned. It shall be the duly of the controlling officer to scrutinize carefully before signing or countersigning a claim in respect of medical expenses, that the claim is genuine and is covered by the rules and that charges claimed are supported by the necessary cash memos, receipts, certificates etc. The controlling authority may reject such claims in case they do not satisfy these conditions.

(3)     The amount due on account of reimbursement of medical expenses incurred shall be drawn on form M.P.T.C.24-A and paid over to them.

(4)     Charges on account of medical attendance and treatment shall ordinarily be debatable to the sub-head "Allowances and Honoraria" subordinate to the major head concerned except in the case of members of the work-charged establishment where they shall be debitable direct to the work concerned.

Rule - 16.

(1)     Rules 3 to 11 shall, in so far as they relate to medical attendance and treatment at hospital apply to the members of the family of a Government employee in the same manner and to the same extent as they apply to Government employee.

(2)     A Government employee shall also be entitled for reimbursement of charges incurred by him for the treatment of his wife during the confinement including pre-natal and post-natal treatment and treatment for abortion:

Provided that, no reimbursement shall be made, if two or more children are living on the date of such confinement:

Provided further that where another child is born to a Government employee, where there are two or more living children, the additional child so born, shall not be entitled to the reimbursement admissible under these rules.

In case of second birth occurring in women bearing multiple pregnancies (twins/triplets etc.), the children so born, shall be entitled to reimbursement admissible under these rules.

Rule - 17.

(1)     Government employee shall also be entitled to reimbursement of expenditure incurred by him on medical attendance and treatment of himself or the members of his family under the Homeopathy or Indian Systems of Medicine in the same manner as to the same extent as laid down in the foregoing rules:

Provided that, the expenditure incurred on the purchase of such medicines, shall be reimbursable in respect of medicines mentioned in the Annexure, as prescribed by the Department of AYUSH, on the signature of the authorized doctor and counter signature of Principal/Divisional Officer, Ayurveda/Superintendent of the dispensary.

(2)     For the purpose of reimbursement under these Rules, an AYUSH doctor in charge of a hospital, shall be deemed to be an authorized doctor.

Rule - 18. Repeal and Savings.

On the coming into force of these rules, the Madhya Pradesh Civil Services (Medical Attendance) Rules, 1958, shall stand repealed:

Provided that anything done or any action taken or purported to have been done or taken under the rules so repealed shall be deemed to be done or taken under the provisions of these rules:

Provided further that all claims for medical reimbursement relating to the period prior to the coming into force of these rules shall be governed by the provisions of the rules applicable to the Government employee concerned, immediately before the coming into force of these rules.

FORM-I

EMERGENCY MEDICAL CONDITION CERTIFICATE

[See Rule 5]

This is to certify that Shri/Smt./Ms….................................S/o, W/o, D/o, family Member of…....................... age….......R/o…......................................................., MP and employee of Government of MP Dept. of…........................................... was admitted in….............................. hospital, address…................................................with IPD Registration No….................. in…........................... department of the hospital, under emergency on DD/MM/YYYY at …............. am/pm with the Provisional diagnosis of…...................necessitating emergency treatment.

The final diagnosis of the patient on discharge from the hospital was established as …..............................

He/she has been charged an emergency treatment fee of Rs. …..................vide enclosed Prescription/hospital invoice/cash memo(s)/Discharge Ticket duly signed by the Medical Officer In-charge.

Name of the Government Employee:…................................................................

Employee Code No…...................................................................................

Office Address…...................................................................................

Contact No…...................................................................................

Date: …...................................................................................

Signature of Medical Officer In-charge

Name of the Medical Officer I/c….................

Registration No….....................................

Seal of Hospital…....................................

Counter Signed by (Name) …....................

Hospital Superintendent of….........Hospital

Seal of Hospital…...............................

Contact No…....................................

FORM-II

FORM OF APPLICATION FOR MEDICAL REIMBURSEMENT

FOR OUT-PATIENT TREATMENT

[See Rule 6] (To be submitted in 2 copies)

*Note: Claims submitted without Prescription in original/photocopy with OPD No. and date, shall not be reimbursed

Date….............

Signature of the Government Employee

FORM-III

CERTIFICATE FOR DISEASE REQUIRING PROLONGED TREATMENT

[See Proviso of Rule 6]

It is hereby certified after clinical examination that Shri/Smt./Ms.......................................... H/o/W/o/S/o/D/o Shri/Smt. .......................................of........................., department is under my out-patient treatment for .......................................................... disease* since...............months/years and is likely to require treatment for prolonged period.

*Name(s) of the chronic disease (s) requiring out-patient treatment for prolonged period to be clearly stated.

Authorized Doctor

Name of the Government Hospital, M.P.

....................................................................................................

Name of Authorized Doctor:

....................................................................................................

(..........................................................)

Counter-Signature of the Civil Surgeon cum Chief Hospital

Superintendent

FORM IV

FORM OF APPLICATION FOR MEDICAL REIMBURSEMENT

FOR IN-PATIENT TREATMENT

[See sub-rule (1) of Rule 9]

(N.B.- Separate Form should be used for each patient)

Declaration to be signed by the Government Employee

I hereby declare that the statements in this application are true to the best of my knowledge and believe and that the person for whom medical expenses were incurred is wholly dependent upon me.

Dated…...........

(….................................)

Signature of the Government

Employee and office to which attached

(….........................................)

Counter-Signature of the Hospital Superintendent

FORM-V

REFERRAL CERTIFICATE FOR IN-PATIENT TREATMENT IN EMPANELLED PVT. HOSPITAL OUTSIDE THE STATE

[See sub-rule (3) of Rule 11]

(1)     Dr. .............................. Professor and Head of Department, .............................. of ............................... Government Medical College, Madhya Pradesh have examined Shri/Smt./Ms....................................... age............ S/o,W/o,D/o. Family Member of Shri/Smt.............................................. on OPD Ticket No................... dated ............. employed in.................................Department as.........................................................

The patient is suffering from..................................... and is referred out of State of Madhya Pradesh for...................................treatment/procedure.

The aforesaid facility of treatment/procedure is not available in the State of Madhya Pradesh.

Date:

Signature and Seal. .............................................

Name.............................................

HoD..........................................Government Medical College, MP

Counter Signed by

Date:

Signature and Seal.

Name.............................................

Dean of.............................................Government Medical

College, MP.

FORM VI

FORM OF ESSENTIALITY CERTIFICATE

[See of sub-rule (2) of Rule 13]

(A)     In case of medicines not included in the Essential Drug List

CERTIIFIED that Shri/Shrimati/Kumari.......................................son/wife/daughter......................employed in the .........................has been [under my treatment from......................to.....................for .....................indoor/outdoor patient and that the undermentioned medicines have been prescribed by me in this connection] These medicines are not included in the Essential Drug List.

These medicines were absolutely essential for the treatment of the afore said Government employee.

Date:

Signature and Designation of the Authorised Doctor

Counter-Signature of Civil Surgeon cum Chief Hospital Superintendent
(Only in cases where he is not himself the Authorized Doctor)

Date:

(B)     in case of medicines included in the Essential Drug List but are Out of stock/Unavailable

I certify that Shri/Shrimati/Kumari............................son/wife/daughter of Shri.......................employed in the..............................has been under my treatment for...............................(name of the diseases) at the ..................hospital from.................to..............as an indoor/outdoor patient and the under mentioned medicines have been prescribed by me in this connection. These medicines are out of stock and unavailable in the .......................... hospital. They do not include any medicines proprietary otherwise outside the Essential Drug List nor are they preparations which are primarily foods, toiletries or disinfectants.

Signature and Designation of the Authorised Doctor

Date

Counter-Signature of Civil Surgeon cum Chief Hospital Superintendent
(Only in cases where he is not himself the Authorized Doctor)

Date