MEGHALAYA MEDICAL ATTENDANCE RULES, 2021

PREAMBLE

In exercise of the powers conferred by the proviso to Article 309 of the Constitution, the Governor of Meghalaya is pleased to make the following rules, namely:-

Rule - 1. Short Title And Commencement.

(1)     These Rules may be called the Meghalaya Medical Attendance Rules, 2021.

(2)     They shall be deemed to have come into force with effect from the date of notification.

Rule - 2. Extent Of Application.

These Rules shall apply to the following categories or person, including their family members:-

(1)     Employees in service and pensioners of the Government of Meghalaya including All India Service Officers in service opting for these rules.

(2)     Retired member of the Joint Assam-Meghalaya Cadre of the All India Services who had served and retired from the Meghalaya Wing, irrespective of their place of permanent settlement, or who are re-employed under Government of Meghalaya, or who proceeded on deputation from Meghalaya Wing to the Central Government or Public Sector Undertaking (PSU).

Provided that in the case of those Officers who retired from the Central Government or Public Sector Undertaking, for whom similar benefit are extended by the Central Government or Public Sector Undertakings, as the case may be, then such officer may opt for benefits either under these Rules or that of the Central Government or the Public Sector Undertaking. Option once exercised shall be final.

(3)     Retired judges of the High Court having jurisdiction over and who are residing in Meghalaya, unless they choose to opt for Rules otherwise applicable to them in this behalf.

Note: (a) In Sub-rule (1) above, employees in service include those on leave/study leave or under suspension.

(b) All India Service means the Indian Administrative Service, the Indian Police Service and the Indian Forest Service.

(c) For the purpose of these Rules, persons in Sub-rule (2) and (3) shall be treated as Officers belonging to the State Government.

Rule - 3. Definitions.

In these Rules, unless there is anything repugnant to the subject or context:-

(1)     'Government' means the Government of Meghalaya.

 

(2)     'Authorised Medical Attendant' means a regular Medical Officer working in a Government hospital/medical institution.

 

(3)     'Government Hospital' means and includes all Hospitals, Civil Hospitals, Community Health Centres, Primary Health Centres, Dispensaries and other Health Institutions maintained by the State Government.

 

(4)     'Patient' means any person needing medical attendance or treatment and belonging to any of the categories specified in Rule 2 and the respective family members thereof.

In-Patient: Patient who requires hospitalization.

Out-Patient: Patient who does not require hospitalization.

(5)     'Medical Attendance' means attendance in Government Hospital or at the residence of the patients and includes:-

(a)      Such pathological, bacteriological, radiological or other methods of examination for the purpose of diagnosis, carried out in Government Hospital or laboratory at the instance of the Authorised Medical Attendant irrespective of whether the patient is hospitalized or not, and

(b)      Such consultation with any other Medical Officer or Specialist in the service of Government as the Authorized Medical Attendant certifies to be necessary to such extent and in such manner as the Medical Officer or the Specialist may, in consultation with the Authorized Medical Attendant, determine.

(6)     'Treatment' means the use of all medical and surgical facilities and includes:-

(a)      The employment of such pathological, bacteriological, radiological, or any other methods as are considered necessary by the Authorized Medical Attendant;

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

(c)      Such accommodation as is ordinarily provided in the Government hospital to which the patient is admitted and is suited to his status;

(d)      The services of such nursing staff as are ordinarily employed by the Government hospital to which the patient is admitted.

(e)      The Medical Attendance described in Sub-Rule (5) (a) and (b) of Rule (3) does not include provision for diet.

(7)     'Family members' include:-

(a)      'Spouse' to also include judicially separated 'Spouse'.

 

(b)      Solely dependent 'parents' to also include 'step-parents' and 'adopted-parents'. In case of adopted-parents, the real parents are to be excluded. A Government employee may opt to include either his/her parents or his/her parents-in-law. Change of option may be allowed only once during service.

 

(c)      Solely dependent son/daughter, brother/sister not exceeding 25 years.

 

(d)      Solely dependent son/daughter, brother/sister, suffering from permanent disability of any kind (physical or mental), with no age limit.

 

(e)      Solely dependent son/daughter, brother/sister, suffering from diseases specified in Annexure-I, with no age limit.

Note: Children include those adopted according to any law or custom.

Rule - 4. Treatment In Government Medical Institutions.

(1)     A patient shall be entitled to Medical Attendance or treatment at the nearest Government hospital within the State, as per user charges notified by the competent authority.

 

(2)     Cost of medicines necessary for the indoor patient purchased by the patient from outside the hospital shall be reimbursed to the Government employees.

 

(3)     Accommodation in Government Hospital shall be provided in accordance with the scale suitable to the status of employees and may be determined by the Government from time to time.

(a)      The accommodation eligibility criteria shall be as follows:-

(b)      Expenditure incurred by the patient in excess of admissible limits shall be borne by the patient himself/herself.

Explanation:-Reimbursement means reimbursement to Govt. employee or Govt. pensioner, as the case may be.

Rule - 5. Treatment At Residence.

Where the Authorized Medical Attendant is of the opinion that, owing to the severity of the illness, a patient, who is not in position to visit the nearest hospital may receive medical attendance and treatment at his residence. A written information is to be sent to the Authorised Medical Attendant about his illness and the patient shall be attended at his residence as per user charges notified by the competent authority.

Rule - 6. Treatment At Another Government Hospital.

If considered necessary, the Authorised Medical Attendant may refer the patient to another Government hospital and the patient shall receive medical attendance and treatment at the referred hospital as per user charges.

Rule - 7.Referral For Treatment Outside Government Medical Institutions/Outside The State.

(1)     Cases requiring specialized treatment in Specialized Institutions outside the Government Medical Institutions, for which treatment facilities are not available within such Institutions, the Authorized Medical Attendant, not below the ranking of a Superintendent of a Government hospital or a District Medical & Health Officer may, with the prior approval of the Director of Health Services (MI), refer the patient for treatment to such recognized institutions and the cost of the treatment thereof shall be reimbursed by the Government, as per the procedure stated at Rule 28 & 29.

(2)     Where accommodation is not available in Government Hospital and where the Authorized Medical Attendant recommends immediate hospitalization, the patient may seek admission in an empanelled hospital and receive medical treatment.

Non-availability of accommodation in Government hospital shall be certified by the following authorities:

(a)      In case of the Civil Hospital at the District or Sub-Divisional headquarters by the Superintendent of the hospital.

(b)      In the case of Community Health Centres and Primary Health Centres by the District Medical & Health Officer in the District in which the Community Health Centre and Primary Health Centre are situated.

(3)     Ex-post facto approval may be given for treatment undertaken in empanelled/non-empanelled hospitals, subject to justification necessitating emergency treatment, without prior approval of the Director of Health Services (MI) as per Rule 29. In such case, the cost of treatment shall be limited to CGHS rates/Approved rates of the State Government.

 

(4)     No reimbursement of the expenses incurred shall be admissible for medical treatment which is not an emergency case and which is without the prior approval from the prescribed authority.

 

(5)     Re-imbursement for master check-up is not admissible except as notified.

 

(6)     A list of such empanelled hospitals is at Annexure-II and is available at www.meghealth.gov.in under Medical Reimbursement.

Rule - 8.

(I)      Accommodation Charge For Different Categories Of Wards

Note: If entitled bed is not available, balance of expenditure for accommodation availed beyond entitlement to be borne by the claimant.

(1)     The accommodation charge to be updated by the Government from time to time.

(2)     There shall be no separate room rent during the treatment in ICCU or ICU.

Rule - 9. Adoption Of CGHS Rates.

(1)     The rates prescribed in the Central Government Health Scheme (CGHS) package by the Government of India, Ministry of Health & Family Welfare Affairs New Delhi, for Central Government Health Scheme are adopted in the State for the purpose of reimbursement of medical expenditure incurred by the State Government employees both in service/retired and their dependents, when the treatment is undertaken in the private hospitals recognized by the State Government both inside and outside the State. The private hospitals recognized as referral hospital should abide and follow CGHS package rates as per mutual agreement while giving treatment to the employee, and their dependents as per MMA Rules.

(2)     The rates will change automatically with the change of the CGHS rates/Approved rates of the State Government from time to time.

The cost of treatment beyond CGHS rates for Hospitalization/treatment shall have to be borne by the employee/pensioner.

Rule - 10. Treatment For Fell Diseases Including Prolonged Outdoor Treatment.

(1)     All types of out-patient treatment, including diagnostics, follow-up treatments, chemotherapy, radiotherapy, regular dialysis for kidney failure are allowed for reimbursement in respect of the treatment obtained as out-patients in private hospitals recognized by State Government and also including out-patient treatment for Cardinal diseases like cardiac diseases, neurological problems and AIDS. The length of out-patient treatment period should be recommended by the Authorized Medical Attendant concerned, subject to approval by the Director of Health Services (MI).

 

(2)     In respect of lifelong follow-up treatment of certain disease, follow-up treatment for post-operative cases, requiring lifelong treatments, the concerned patient has to get revalidation of prescription once in a six months from the Authorized Medical Attendant and reimbursement be allowed subject to scrutiny of the Director of Health Services (MI).

 

(3)     Fell disease like Tuberculosis, Cancer, Polio and other chronic disease like Chronic Bronchitis, Chronic Obstructive Pulmonary diseases, Peptic Ulcer, Heart disease, Diabetes Mellitus and its complications, Mental diseases, Psychosis, Epilepsy, Paraplegia, Chronic Disorder of Nervous System, Spinal Cord Compression, Cerebral Palsy, Parkinson's Disease, Neuromuscular Dystrophies, Chronic Disease of the Eye, Liver Cirrhosis, Hepatitis B, Chronic Renal Failure, AIDS, Systemic Lupus Erythematosus, Blood Disorders etc. which require prolonged treatment, whether in the hospital or outside, involving use of costly medicines purchased on an authorized prescription shall be fully reimbursable.

Provided that reimbursement of the cost of preparation, which is primarily of food, toiletries/toilet preparations, disinfectant, etc., shall not be admissible.

Rule - 11. Matters Relating To Reimbursement In Pregnancy And Childbirth (Confinement).

(1)     As per O.M No.F(PR)-76/2017/21, dated Shillong the 8th December 2017, Government employees are entitled to 180 days Maternity Leave and 15 days Paternity Leave, subject to the facility being available for a limit of 2(two) surviving children only.

 

(2)     The pre-natal and post-natal treatment can be had at the Government Medical Institutions in the State where facilities are available and where no such facilities are available, the case to be referred to the nearest Government Specialist/recognized hospitals concerned by the Authorized Medical Attendant.

 

(3)     Medical reimbursement for deliveries and tubectomy of a Government employee or the wife of Government employee is allowed for two deliveries only as per the CGHS rates/Approved rates of the State Government.

Provided that the reimbursement will be eligible for Government employees only for first and second delivery, i.e., 1st surviving child and 2nd surviving child. No reimbursement will be allowed for delivery of 3rd child onwards. Provided further that the decision of Government in Health & F.W. Department shall be final.

Rule - 12. Dental treatment.

(1)     In respect of Dental treatment cases, the employees should approach Government Hospital for Dental treatment or where, facilities are not available, obtain referral letter before approaching any recognized private Dental Hospital for treatment. With the prior permission of the competent authority only, one can obtain dental treatment in recognized Dental Hospitals. The procedure for referral is similar to the procedure in other cases, vide Rule 7.

(2)     The expenses incurred in connection with the following type of Dental treatment may be reimbursed:-

(a)      Extraction.

 

(b)      Scaling and gum treatment.

 

(c)      Filling of teeth.

 

(d)      Root Canal Treatment.

 

(e)      Surgical operation needed for removal of Odentones and impacted wisdom tooth also fall under the category of Dental treatment of a major kind.

 

(f)       Treatment of gum boils come under oral surgery (of the mouth) and as such is admissible under the rules.

 

(g)      Expenses incurred towards the treatment of Pyorrhoea and gingivitis may also be reimbursed as it is covered under the term "gum treatment".

Note: The above list is indicative and not exhaustive.

(3)     Reimbursement of complete denture - Reimbursement of the cost of complete denture up to the ceiling limit of Rs. 2000/- (Rupees Two Thousand) only and the ceiling limit for reimbursement of a complete Denture of one Jaw would be Rs. 1000/-(Rupees One Thousand) only may be considered only if the procedure is advised as essential and should be considered only.

(a)      If the same has been advised and considered essential by the Specialist (Dental Surgeon) of a Government Hospital.

 

(b)      In case there is no Government Hospital where facilities for Dental treatment are available, then on the recommendation of a Dental Surgeon of a recognized hospital, provided the patient has been referred by the Authorized Medical Attendant to that hospital.

 

(c)      The Reimbursement of complete/partial denture can be permitted on one-time basis only.

 

(d)      The concerned department shall obtain an undertaking from the applicant that he/she has not claimed the reimbursement from the Government in the past and will not claim in future as per Annexure-III.

(4)     If the diagnosis of the physiological or other disability from which a Government employee/pensioner is suffering indicates that teeth are the real source of ailment, he/she is entitled to free Dental treatment of a major kind, such as, treatment of a jawbone disease, wholesale removal of teeth, etc.

(5)     Claims regarding Cosmetic dental surgery (e.g. Dental Implants, Bridge, etc.) are not eligible for any medical reimbursement, except in case of Road Traffic accidents involving upper and lower jaws or accidents in the line of official duty.

Rule - 13. Hearing Aid.

Refund in respect of purchase of hearing aid shall be allowed twice during the entire services of a Government Servant, or to his family members, subject to the following conditions:

(1)     The reimbursement of charges will be admissible on the basis of the certificate issued by the Head of the ENT Department in a Government Hospital. The certificate should specify that the Government servant is required to use hearing aid in the right or left or both ears.

(2)     The maximum Ceiling limit will be as under:-

(3)     The concerned Department shall obtain an undertaking from the applicant as per the format at Annexure IV.

Note: Procedure for reimbursing purchase of hearing aid will as per Rule 28 & 29.

Rule - 14. Spectacles.

(1)     As approval is given for treatment of High Myopia but there is no provision for procurement of spectacles, Reimbursement in respect of the cost of spectacles, where necessary, shall be allowed thrice during the entire service of the Government servant up to a ceiling rate of Rs. 5000/- (Rupees Five Thousand) only, in each case.

(2)     Intraocular lens (IOL) used in Cataract Surgery are allowed and ceiling limit for IOL shall be fixed at CGHS Approved rates.

Note: The Concerned Department shall obtain an undertaking from the applicant as per Annexure-V.

Rule - 15. Artificial Appliances.

For the purpose of this Rule, 'artificial appliances' in general, are indicated below:-

(1)     Prosthetic appliance of all kinds for upper and lower limbs;

 

(2)     Spinal braces or spinal supports including spinal belts;

 

(3)     Cervical collars of all kinds, such as, of plastic, leather or stainless steel with leather coverings;

 

(4)     Leather and Metallic splint devised for correction of deformities and providing support for upper limbs;

 

(5)     Bracerage of all kinds including, calipers, knee cage, knock knee and bow legs splints made of metal and leather and;

 

(6)     Orthopaedic shoes, boots and splint used for correction of deformities of feet and legs. Reimbursement in respect of the cost of Polio boots shall be allowed only at intervals of not less than three years and may be claimed only three times in respect of an individual.

 

(7)     Heart valves, Orthopaedic prosthesis, Pace Maker, etc.

Note: (A) The list as per Annexure VI is only indicative and not exhaustive. The ceiling for the procurement of the above will be as per CGHS rates/Approved rates of the State Government.

(B) Procedure for reimbursing purchase of artificial appliances will be as per Rule 28 & 29.

Rule - 16. Continuous Positive Airway Pressure (CPAP)/Bilevel Continuous Positive Airway Pressure (BIPAP) CPAP/BIPAP.

CPAP/BIPAP machine for domiciliary use of beneficiaries covered under MMA Rules may be allowed subject to fulfilment of the following conditions:-

(1)     Individual request for approval should be considered by at least two Medical Specialists in the concerned field and the Medical Superintendent of a Government Hospital.

 

(2)     Request should be accompanied by copies of Sleep Lab Report and all basic investigation reports.

 

(3)     Concerned beneficiary should submit undertaking for return of the machine to the Department concerned after its utility is over. The concerned Department shall obtain an undertaking from the applicant as per Annexure - VII.

 

(4)     The maximum ceiling will be as under:-

CPAP Machine - Rs. 50,000/-BIPAP Machine - Rs. 1,00,000/-

Rule - 17. In-Vitro Fertilization (IVF).

(1)     IVF procedure will be allowed in a Government Medical Institution on the recommendations of the Head of Department of Gynaecology and Obstetrics of a Government Medical Institution.

 

(2)     IVF procedure may be allowed, on case-to-case basis, in private Medical Institution if the Institution is registered with the State/Central Government and has the necessary facilities including equipment and trained manpower for carrying out the procedure. It is however, mandatory to obtain the recommendations of the Head of Department of Gynaecology and Obstetrics of a Government Medical Institution for permitting the procedure to be undertaken in a private Institution.

 

(3)     There should be clear evidence of failure of conventional treatment before permitting IVF treatment procedure.

 

(4)     The woman has to be married and living with her husband.

 

(5)     The IVF treatment procedure will be allowed only in cases of infertility where the Government servant has no living issue.

 

(6)     Reimbursement of expenditure incurred on IVF procedure will be allowed up to maximum of 3 (three) fresh cycles.

 

(7)     An amount not exceeding Rs. 65,000/- (Rupee Sixty Five Thousand) only per cycle or the actual cost, whichever is lower will be allowed for reimbursement. This amount will be inclusive of the cost of Drugs and disposables and monitoring cost during IVF procedures.

 

(8)     As IVF treatment is a planned procedure, reimbursement cases can be considered by the Departments only if prior approval was obtained by the beneficiary for undergoing the IVF treatment.

 

(9)     There will be a one-time permission for availing IVF treatment consisting of three cycles in total, which would be admissible to the beneficiary. The concerned Department shall obtain an undertaking from the applicant that he/she has not claimed the reimbursement earlier from the Government of Meghalaya in the past and will not claim in the future as per Annexure VIII.

Rule - 18. Kidney & Liver Transplant.

(1)     The ceiling for reimbursement with respect to Kidney Transplant will be at CGHS rates/Approved Rates of the State Government.

 

(2)     The ceiling for reimbursement with respect to Liver Transplant will be at CGHS rates/Approved Rates of the State Government.

 

(3)     The package rate for Liver Transplantation surgery involving live Liver donor shall be as follows:-

Rs. 11,50,000/- (Rupees Eleven Lakhs Fifty Thousand) only + pre transplant evaluation of a donor and recipient Rs. 2,50,000/- (Rupees Two Lakhs and Fifty Thousand) only.

(4)     The package for Liver Transplant involving a deceased donor shall be:-

Rs. 11,00,000/-(Rupees Eleven Lakhs) only. This includes the cost of consumables during the organ retrieval and the cost of preservative solution, etc.

(5)     The package charges in (3) & (4) above include the following:-

a.        30 days stay of the recipient and 15 days for the donor starting 1 day prior to the transplant surgery.

b.        Charges for the medical and surgical consumable, surgical and procedure charges, operation theatre charges, anaesthesia charges, pharmacy, investigations and in-house doctor consultation for both donor and recipient during the above period. This also includes all post-operative investigations and procedures during the above-mentioned period.

(6)     The package excludes:

(a)      Charges for drugs like Basiliximab/Daclizumab, HBIG and Peg Interferon.

 

(b)      Cross matching charges for blood and blood products.

 

(c)      The extra stay, if any, may be reimbursed after justification by the treating specialists for the reason of additional stay and as per CGHS guidelines.

 

(d)      The drugs mentioned above would be reimbursed as per CGHS/Approved rates or actual whichever, is lower.

Rule - 19. Government Servant Working Outside The State/On Tour/Retired Government Servants Settled Outside The State.

(1)     If the Authorized Medical Attendant has been notified for the place where the Government Servant resides, such MMA is authorized to refer him/her to any empanelled medical institutions within his jurisdiction and separate approval of DHS (MI) will not be necessary. However, the reimbursement of the expenditure incurred for such treatment will require approval from DHS(MI) as per procedure for reimbursement.

 

(2)     If no Authorized Medical Attendant has been notified for the place where the Government Servant resides, the Government servant working/retired/on tour/undergoing study may seek treatment at the empanelled hospitals which also serve as approving authority for treatment. The reimbursement of the expenditure will require approval from DHS (MI) as per procedure for reimbursement.

 

(3)     If no Authorized Medical Attendant has been notified for the place where the Government Servant resides, and no empanelled hospital exists, the medical treatment obtained at the non-empanelled hospitals will be treated as an emergency treatment and the procedure for the treatment and reimbursement will be the same as that for an emergency treatment as per CGHS rates/Approved rates of the State Government.

Rule - 20. Indian System Of Medicines.

When treatment is taken under the indigenous system of medicines, either in the Government Institutions, or under private doctors the procedure prescribed for getting reimbursement of cost of medicine purchased by the persons entitled to free medical attendance or treatment shall be the same as in cases under allopathic treatment.

Rule - 21. Insurance.

A Government servant who is covered under any health insurance scheme other than the Megha Health Insurance Scheme (MHIS) is eligible to claim the reimbursement of the balance amount of treatment, if any, after reimbursement by the insurance company, subject to the condition that such a balance amount, fully or partially, qualifies to be considered for reimbursement by the State Government as per prescribed procedure for reimbursement under these Rules.

Rule - 22. Travelling Allowance For Patient.

(1)     When a patient is required to travel from his Headquarters to a referred Hospital on the advice of the Authorised Medical Attendant as provided in these Rules, he shall, if he is a Government servant, be

 

(2)     Entitled to Travelling Allowance as per the entitlement as on tour from his Headquarters to the referred Hospital and back.

 

(3)     A Member of a Government servant's family (patient) who is not a Government servant will be entitled to the same rates of Travelling Allowance as applicable to the Government servant.

 

(4)     A pensioner of the categories specified in Sub-rules (1) and (2) of Rule 2, shall be entitled to the rates of T.A. which the pensioner was entitled to, as a Government servant, immediately before his retirement.

 

(5)     Government employees will be reimbursed T.A. as per entitlement for the journey performed by them for the purpose of medical treatment undertaken by them in empanelled hospitals outside the State Government Medical Institutions, without prior approval of the Director of Health Services (MI), subject to ex-post facto approval by the Director of Health Services (MI) as per procedure prescribed in Rule 29 of these Rules.

 

(6)     No T.A. will be entertained for cases which are non-emergency in nature and where no prior approval from competent authority has been obtained.

 

(7)     Where the patient is not in a condition to travel by rail and road, the patient and the attendant may, with the prior approval of the Director of Health Services (MI, be allowed to travel by air for the outward journey. The air travel for inward journey is as per Rule 27 (3).

Rule - 23. Attendants Accompanying The Patient.

(1)     Where the Authorised Medical Attendant considers it necessary, he may allow an attendant to accompany the patient from Headquarters to the referred Hospital and back.

(2)     The attendant shall be entitled to same rate of Travelling Allowance as applicable to the patient. The entitlements for travelling, in case of patient and attendant are indicated in the Table below:-

Note: An attendant/escort is a person who actually accompanies and travels with the patient

(3)     Two escorts may be allowed only in exceptional case, viz., in case of the patient being a mentally retarded person or in non-ambulatory illness of a severe nature or in case of a child below 5 (five) years on the specific recommendation of the Standing Medical Board.

 

(4)     In cases where both the husband and wife are serving government employees under the State/Central or local bodies/autonomous organization/Government undertakings in connection with medical treatment and claims for reimbursement, claim may be preferred for self and the eligible members of the family and according to his/her status subject to furnishing of joint declaration for availing the concession by one of them.

Rule - 24. Exclusion Of Treatment In Private Institutions.

Government do not undertake any liability to reimburse the expenses incurred by a patient for medical attendance, or treatment, including purchase of drugs, medicines, sera, vaccines, etc, in a private Institution, even if prescribed by the Authorized Medical Attendant, except as provided specifically in these Rules.

Rule - 25. Medical Allowance.

(1)     A Medical Allowance, at a flat rate as may be fixed by Government from time to time, shall be paid to every Government Servant to cover the expenses on minor ailments not requiring prolonged treatment or hospitalization outside Government hospitals.

(2)     In similar cases, since AIS officers are not in receipt of Medical Allowance, they are eligible to draw the expenses incurred as per Office Memorandum at Annexure - IX & Annexure-X.

Rule - 26. Advance For Expenses On Treatment.

(1)     The State Government may grant an advance to the patient not exceeding three fourths of the approved rates in respect of such ailment/medical intervention in an approved institution subject to a Certification by the Director of Health Services (MI).

 

(2)     Additional Medical advance in cases already undergoing medical treatment and for which an Estimate Certificate from the treating authority is submitted regarding further treatment planned and required may be allowed only if earlier advance taken has been fully utilised/adjusted.

 

(3)     The advance shall be adjusted against the final reimbursement bill without delay.

 

(4)     An amount in excess of the final bill shall be refunded by the Government servant in one single instalment.

Provided that the Government may allow such refund in monthly instalments after considering the pecuniary circumstances of the patient.

(5)     All government employees/pensioners who have drawn Medical Advance should submit their final reimbursement bill within 6 months from the date of completion of treatment failing which their claim will not be entertained.

 

(6)     Cases referred for treatment to un-empanelled hospitals are to be examined by DHS (MI) in its true perspective and on satisfying that the needs are genuine and deserve to be recommended can be done so at the level of the DHS (MI) subject to condition that no medical advance is recommended/sanctioned.

Rule - 27.Procedure For Approval Of Treatment As Referral Cases And For Inward Air Journey.

(1)     All applications for approval should be forwarded by the concerned Department of applicant - as per Director of Health Services (MI), Meghalaya, Shillong Order No.HSM/T/ST/MISC/5/2002/1186-97, dated 27th January, 2009. (Enclosed as Annexure-XI), along with:-

(a)      Referral OPD Ticket/Certificate in original.

 

(b)      Recommendation of Hospital/District Head in original - Annexure- XII

 

(c)      Annexure - XIII, duly filled in, as applicable and verified by the Head of Office, in respect of family members which has been defined in Rule 3(7)

(2)     Applications for approval for subsequent Medical Review as advised by the treating authority are mandatory and are to be forwarded by the Controlling Officer of the applicant along with:-

(a)      Last Approval order issued by the Director of Health Services (MI).

(b)      Advice from treating Institution for Medical Review.

(c-i) A self-attested copy of the applicant's Pay Slip issued by the Accountant General.

OR (c-ii) Duly filled Annexure XIV- as per OM No.Health.230/2000/247, dated 28/06/2006 and other particulars verified by the Head of Office.

(3)     Applications for Inward Journey by Air should be submitted separately from the final bill and should be accompanied by:-

(a)      Approval order pertaining to treatment for which journey was performed.

(b)      Advice from treating Institution to Travel by Air - as per OM.No.Health.230/2000/247, dated 28/06/2006 is to be furnished in the following format: "In view of the health condition of the patient, it is advised that the mode of travel for the return/inward journey should be by air only (in cases not entitled)"

A self-attested copy of the applicant's Pay Slip issued by the Accountant General OR a duly verified and filled Annexure XIV should be attached.

Note: All approvals are to be collected from Office of the Director of Health Services (MI) by the Applicant. On receipt of the Approval applied for, due attention should be given to the instructions given in the last para of the said Approval order.

Rule - 28. Procedure For Medical Reimbursement Claims.

Where Approval has been issued by Director of Health Services (MI), the following documents are to be submitted:

(1)     Copy of Approval Order pertaining to period of treatment submitted for claim.

 

(2)     Duly filled in Annexure XIV - as per OM.No.Health.230/2000/247, dated 28/06/2006 duly verified by the Head of Office.

 

(3)     Copies of Discharge Summary/Medical Report/Advice Slips or Prescriptions pertaining to each bill/Cash memos submitted for claim.

 

(4)     Essentiality Certificate (Annexure-XV/XVI) and Bills/Cash memos in ORIGINAL should be duly verified/signed by the authorized signatory of the treating Institution.

 

(5)     Sanction order (for Government Employees of Health & Family Welfare Department only).

 

(6)     The claim should be forwarded to Director of Health Services (MI) through Concerned Department.

 

(7)     Other relevant Annexures, as applicable, duly verified by the Head of Office.

Note: Medical Reimbursement bills should be collected by the Concerned Department from the Office of the Director of Health Services (MI).

Rule - 29.Procedure For Emergency Medical Treatment/Ex-Post Facto Approval.

Where prior approval has not been obtained from the Director of Health Services (MI), the following documents are to be submitted:-

(1)     Annexure -XIV or Annexure- XIII and XIV, as the case may be, duly filled up as applicable and verified by the Head of Office.

 

(2)     Copies of Discharge Summary/Medical Report/Advice Slips/Prescriptions pertaining to each bill/Cash Memos submitted for claim.

 

(3)     Essentiality Certificate (Annexure _XV OR Annexure _XVI) along with the Bills/Cash memos in ORIGINAL should be duly verified/signed by the authority of treating institution.

 

(4)     Referral Certificate by AMA (Authorized Medical Attendant)/Emergency Certificate from Authority of Treating Institution.

 

(5)     Bills should be forwarded by Concerned Department.

 

(6)     Other relevant Annexures as applicable and duly verified by the Head of Office.

Rule - 30. Delegation Of Financial Powers.

(1)     In referral cases, where CGHS rates/Approved rates of the State Government are available, the Joint Director of Health Services (Garo Hills Division) based at Tura are authorized to approve treatment cost upto 3 lakhs in each case but reimbursement claim is to be approved by the Director of Health Services (MI)

 

(2)     However, in cases where CGHS rates/Approved rates of the State Government are not available, the procedure shall be the same as in other referral cases.

Rule - 31. Instructions.

(1)     In order to facilitate implementation of the Rules, instructions to the

(a)      District Head/Hospital Head.

 

(b)      Controlling Officer.

 

(c)      Government employees are provided as per Annexure-XVII.

(2)     An indicative admissible/non-admissible items for reimbursement of medical bills is at Annexure-XVIII.

 

(3)     A format for undertaking in case of lost documents is at Annexure-XIX.

Rule - 32. Relaxation Of The Rules.

Where the Government of Meghalaya is satisfied that the operation of any of these Rules causes undue hardship in any particular case, it may, by order, dispense with, or relax the operation of that Rule to such extent, and subject to such conditions, as it may consider necessary, in a just and equitable manner.

Rule - 33. Power Of Interpretation.

If any question arises relating to the interpretation of these Rules, it shall be referred to the Government of Meghalaya in the Health & Family Welfare Department whose decision thereon shall be final.

Rule - 34. Repeal.

The Meghalaya Medical Attendance rules, 1981 (as amended) stand repealed.