The Role and Functions of the Medical Cell in the West Bengal Health Scheme
The Government of West Bengal has established a dedicated Medical Cell under the Finance Department (Group-P2) to oversee the administration of the West Bengal Health Scheme. This specialized unit plays a crucial role in ensuring that state government employees and pensioners receive timely and effective healthcare services. Below, we explore the various functions and responsibilities of the Medical Cell.
Overview of the Medical Cell Functions in the West Bengal Health Scheme
| Function | Description |
|---|---|
| Issuance of Operational Guidelines | In collaboration with the Health and Family Welfare Department, the Medical Cell issues guidelines and clarifications for the implementation of the West Bengal Health Scheme |
| Permissions for High-Cost Medical Procedures | The WBHSA grants necessary permissions for high-cost procedures, including various implantations, chemotherapy, and non-package treatments with significant costs. |
| Consultation for Out-of-State Treatments | Departments must consult the WBHSA before approving treatments in specialty hospitals outside the state, except for certain exceptions. |
| Rate Fixation for Surgical Procedures | The Medical Cell periodically sets approved rates for surgical procedures and medical investigations to ensure standardized costs across empanelled hospitals and diagnostic centers. |
| Empanelment of Health Care Organizations | The Medical Cell has the authority to empanel and classify private hospitals, nursing homes, clinics, laboratories, and diagnostic centers within the state as Class-1 and Class-2 service providers based on available facilities. |
| Processing Cashless Treatment Claims | The Medical Cell checks and approves claims from HCOs for cashless treatments, making payments up to ₹1,50,000 and issuing CARCs for claims exceeding this amount. |
| Advisory Role | Acts as an advisory body for other health schemes implemented by the Government of West Bengal, utilizing its expertise for broader state healthcare initiatives. |
Issuance of Operational Guidelines
- The Medical Cell, in consultation with the Health and Family Welfare Department, is responsible for issuing operational guidelines and clarifications essential for the smooth implementation of the West Bengal Health Scheme.
- This ensures that all procedures and policies are clearly communicated and adhered to by the relevant stakeholders.
Permissions for High-Cost Medical Procedures
The West Bengal Health Scheme Authority (WBHSA), the apex policy-making body of the Medical Cell, grants necessary permissions for various high-cost medical procedures. These include:
- More than two procedures where the total cost exceeds ₹50,000.
- Implantation of more than two Drug Eluting Stents.
- Implantation of AICD (Automatic Implantable Cardioverter Defibrillator).
- Implantation of CRT (Cardiac Resynchronization Therapy) with AICD.
- Implantation of Deep Brain Stimulator.
- Implantation of Intra-Thecal Pumps.
- Implantation of Cochlear Implants.
- Implantation of Spinal Cord Stimulator.
- Chemotherapy/Immunotherapy where the medicine cost exceeds ₹50,000 per cycle (once for the entire chemotherapy schedule).
- Non-package treatment costs exceeding ₹5,00,000 for Tata Medical Center, Rajarhat, and ₹3,50,000 for other private empanelled hospitals.
- Successive permissions after every ten days for non-packaged treatment costs exceeding ₹5,00,000 for Tata Medical Center, Rajarhat, and ₹3,50,000 for other private empanelled hospitals.
Consultation for Out-of-State Treatments
It is mandatory for any department to consult the WBHSA before granting permission for treatments in specialty hospitals outside the state, with certain exceptions. This ensures that all out-of-state treatments are necessary and justified.
Rate Fixation for Surgical Procedures
The Medical Cell is responsible for periodically fixing the approved rates for various surgical procedures and medical investigations. This helps in maintaining standardized costs for treatments across all empanelled hospitals and diagnostic centers.
Empanelment of Health Care Organizations
- The Medical Cell has the authority to empanel private hospitals, nursing homes, institutions, clinics, laboratories, and diagnostic centers within the state.
- These facilities are classified into Class-1 and Class-2 service providers based on the available facilities. This classification ensures that beneficiaries receive quality healthcare services.
Processing Cashless Treatment Claims
- For cashless treatments, Health Care Organizations (HCOs) submit the entire bill to the Medical Cell. The cell checks and approves the admissibility of the claim, making payments up to ₹1,50,000.
- Additionally, it issues a Claim Admissibility Reimbursement Certificate (CARC) for reimbursement claims exceeding ₹1,50,000 for employees and pensioners.
- There is a change regarding cashless treatment, please read this order-92F
Advisory Role of Medical Cell
The Medical Cell also acts as an advisory body for any other health schemes implemented by the Government of West Bengal. This ensures that the expertise and experience of the Medical Cell are utilized in the broader context of state healthcare initiatives.