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North Western Railway

INVITING APPLICATIONS FOR EMPANELMENT OF HOSPITALS IN HISAR CITY OF BIKANER DIVISION, NORTH WESTERN RAILWAY North Western Railway invites the offers from private hospitals empanelled with the Central Government Health Scheme (CGHS) on CGHS approved rates for recognizing them for treatment of Health beneficiaries of N.W.Rly. located in the jurisdictions of Hisar City of Bikaner division. The private hospital has to enter into MOU with Chief Medical Superintendent, North Western Railway, Lalgarh, Bikaner 334004 to provide cashless medical services for treatment of the N.W. Railway Health beneficiaries, including Retired Employees Liberalized Health Scheme (RELHS) beneficiaries.

The conditions for cashless service are as under:- (1) The Railway patient will produce a referral slip issued by Northern Western Railway

authorized medical authorities. (2) The authenticity of patient will be verified as per photograph fixed on the referral slip and

valid medical card/RELHS Card issued by the Railways. (3) After the treatment is over, the bills will be raised to the Railway Medical Authorities with

whom the MOU has been signed. (4) The rates will be charges as per CGHS approved rates or lower for that area/nearby

areas, and as per agreement for the items not listed under CGHS rate list.

Offers should be addressed to the Chief Medical Superintendent, North Western Railway, Lalgarh, Bikaner 334004. Offer should include proposal, their offered rates (CGHS/NABH/ Non-NABH, hospital rates), letter of willingness, facilities available with technical aspect as per policy (i.e. number of beds/ facilities/specialties/services offered/medical set up etc. at the proposed hospital) and duly filled form should reach the office of Chief Medical Superintendent, North Western Railway, Lalgarh, Bikaner 334004 as mentioned above, latest by 21st March, 2016. Procedure for recognition will be as per existing latest guidelines of Rly. Board (No.2016/H-1/11/58/Policy dated 25.4.2018) which will supersede all previous guidelines issued from time to time. North Western Railway reserves the right to accept or reject the offers received. In case of any query, the same can be verified from Chief Medical Superintendent, North Western Railway, Lalgarh, Bikaner 334004 on any working day between 10.00 AM to 05.00 PM (Monday to Friday). The detailed terms and conditions and Application Form are published on the website of North Western Railway i. e. www.nwr.indianrailwavs.gov.in

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North Western Railway

EXPRESSION OF INTEREST FOR EMPANELMENT OF HOSPITALS

Chief Medical Superintendent, North Western Railway, Lalgarh, Bikaner 334004

North Western Railway invites application for empanelment of HOSPITALS OF BOTH SUPER MULTI/SINGLE SPECIALITY RUN BY CORPORATE/PRIVATE/TRUSTS AT HISAR CITY OF BIKANER DIVISION Interested parties may apply for empanelment with Bikaner Division of North Western Railway. Last date for submission of application: 21st June, 2018 APPLICATION FORM : Application form can be downloaded from the website of North Western Railway at www.nwr.indianrailways.gov.in The duly filled in form should be submitted along with all documents in a sealed cover to the Chief Medical Superintendent, North Western Railway, Lalgarh, Bikaner 334004 SUBMISSION OF APPLICATION FORMS (a) The application must be submitted in duplicate.

(b) The applicant must indicate under which category the application is being made (Single/

Multi-speciality).

(c) Application form should be submitted in one sealed envelope superscribed as Application

for empanelment of hospital with North Western Railway.

(d) All the pages of Application and Annexures (each set) shall be serially numbered.

(e) Every page of application form and annexures needs to be signed by the competent

person. The signatory must mention as to whether he/she is the sole proprietor or

authorized agent. In case of partnerships, a copy of the partnership agreement duly

attested by a notary should be furnished. Similarly, in case of authorization, appropriate

legal documents should be furnished.

(f) Applications for empanelment must be submitted at the office of Chief Medical

Superintendent, North Western Railway, Lalgarh, Bikaner 334004 as mentioned above.

(g) As far as possible, all information should be given in the application. If a particular facility

is not available, it should be entered as not available, it should not be mentions as not

applicable.

(h) The application is liable to be ignored if the information given on eligibility criteria is not

complete.

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A. Criteria for Empanelment of Multi-specialty Hospital:

1. Bed capacity: The hospital should have sufficient Indoor bed capacity including the ICU/NICU/ICCU. The inspecting team will survey the quality of health care services of that area so that the railway beneficiaries get the best possible health care available in that area.

2. The multispecialty hospital should have capacity to cater to all the emergencies in Medicine, Surgery, Pediatrics, ENT, Neurosurgery, Orthopedics Gynecology, Urology, Nephrology, Cardiology, Pulmonology, and other branches of medicine.

3. The ICU/NICU/ICCU should be available with all infrastructure and facilities available, equipped with modern instruments and compatible with all norms and standards of ICU/NICU/ICCU. It should have following minimum standards:

(a) The Unit I.e. ICCU/NICU.ICCU must have round the clock availability of trained doctors.

(b) The unit should have well trained doctors and qualified para-medical staff with proper facilities to handle emergencies, critical care patients round the clock as per the norms.

4. The hospital should have the ambulance facility of their own and one of them should be equipped with critical care facility manned by trained and qualified doctor and Para medical staff whenever required.

5. The hospital should have easily accessible casualty room preferably at the ground floor manned by trained and qualified doctors and Para medical staff with the facilities to handle all the emergency cases.

6. The hospital should have their own infrastructure of Radiology under same roof to carry out all the essential radiological investigation. Should have the portable X-Ray unit and the USG Doppler unit for non-ambulatory cases. CT and MRI is preferable. The department should be manned by qualified and trained medical and Para-medical staff.

7. The hospital should have minimum three tier facilities for indoor admission i.e .General ward, semi-private ward and private ward as specified by the CGHS for the patients of North Western Railway of different status of entitlement, whenever required.

8. The hospital preferably be recognized by Central Government Health Scheme/ ECHS/

ESI.

9. Operation Theatre: There should be minimum two separate Modular 0.T. in multi-specialty hospital to handle the different surgical emergencies. The O T should comply to standards laid down, compatible with the specialty concerned. It should have facilities of C-Arm, Laparoscopes and necessary infrastructure and equipment of anaesthesia as per the modern standard.

10. The hospital should have the valid registration with the valid registration with the competent authority of City and comply with their standards at any given time.

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11. They should have their own PAN/TIN number and Income-tax clearance certificate at least for past threeyears.

12. The Super-speciality hospitals, like, cardiology, gastro-enterology and neurology should comply with the standards laid down for the respective speciality. They should have their own cardiac cath lab, Operation theatre compatiblewith cardiac surgeries, neuro-surgeries, endoscopy, ERCP, Laparoscopyetc.

13. They should have in-house pathology, laboratory carrying out all the essential bio-chemistry, pathology and microbiology investigations.

14. They should have their own power back up system for uninterrupted power supply.

15. They should have Hospital Waste Management System in place.

16. They should comply with all statutory requirement of State Government/Local bodies.

17. Tariff:

(a) The treatment charges limited to the ceiling of CGHS current approved rates for that particular locality/in case the CGHS rates are not available for that particular city then the rates of adjoining city for which the CGHS rates are available. Or the actual rates of hospital, whichever is less.

(b) Total cashless treatment to the serving and retired railway employees and their dependent on production of valid medical card and official referral letter under North Western Railway should be provided and the bill in triplicate should issued on monthly basis.

(c) All the patients will produce a valid referral slip from the authorized Medical Officer of Railway which is valid for seven days and carries an attested photograph of the patient.

(18) The Hospital having accreditation with NABH and other agencies will be preferred. Similarly, labs in the hospital should be preferably NABL accredited.

(19) Mode of Payment- No advance shall be paid. Full payment will be made against the final original bill after scrutiny. The code no. should be mentioned against each item of bill as mentioned in CGHS Rate List. If any item/procedure which is not mentioned in the list of CGHS it will be paid as per the rates agreed upon in the Memorandum of Understanding (MOU).

(20) The empanelment will be for two years, renewal will be done after every two years based on performance of the hospital and performance will be reviewed by the duly constituted Committee from time to time by the HQ. In case of unsatisfactory performance, hospital will be liable for de-empanelment.

(21) PERFORMANCE BANKGUARANTEE (PBG)

Healthcare organizations that are recommended for empanelment after the initial assessment shall also have to furnish a performance bank guarantee valid for a period of 30 months, i.e., six months beyond empanelment period to ensure efficient service and to safeguard against

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any default. The Performance Guarantee for private hospital is ऱ 2 Lacs (all specialities) and

ऱ 50,000/- for single speciality.

Other terms and conditions for multi-speciality/single speciality hospital:

1. The Hospital should admit the patient immediately on Referral and start the treatment. They should not ask the patient party to deposit any money.

2. The patient Referred should be treated as per referred advice and investigation/procedure may be dealt accordingly.

3. The final bills after the discharge should be issued to concerned Medical Officer andthe record of such should be kept in the hospital administration/Finance section for any requirement in future. The payment will be made, after receipt of the bill at MD/CMS/ACMS office.

4. The Non-admissible items, like, toiletries, cosmetics, nutrient supplies etc. must not be prescribed and included in the bills to avoid complications in finalizing the claim.

5. Any patient without an official referral letter should not be entertained on North Western Railway account, except conditions which will be mentioned in the MoU.

6. North Western Railway will have all the rights to de-empanel the hospital at any time, if any deficiency in the services is noticed.

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North Western Railway

APPLICATION FOR EMPANELMENT OF HOSPITALS

1. NAME OF THE HOSPITALS

Address:

2. HOSPITAL ADMINISTRATION

3. TELEPHONE/FAX/Email

4. EMPANELMENT APPLIED FOR :

(a) Multi-speciality Hospital

(i) Experience

(b) Single speciality Hospital

(i) Speciality

5. TOTAL NO. OF BEDS _______________________

CATEGORY-WISE NUMBER OF BEDS AVAILABLE

(I) Casualty/Emergency Ward: ________________

(II) ICCU/ICU/NICU ________________

(III) General ________________

(IV) Semi-Private As per CGHS ________________

(V) Private Guidelines ________________

6. Staff Pattern:

(a) Doctors with Qualification:

(i) Full Time Specialist : (ii) Visiting : (iii) RMO with Qualification :

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(b) Nursing Staff Nos. with Qualification

(c) Para Medical Staff Nos (Category-wise)

(Attach separate sheet if necessary)

7. Laboratory facility available (In-house)

(a) Pathology Yes______ No _____

(b) Microbiology Yes______ No _____

(c) Biochemistry Yes______ No _____

8. Imaging Facility

(a) X-Ray Yes______ No _____

(b) Sonography Yes______ No _____

(c) CT Scan Yes______ No _____

(d) MRI Yes______ No _____

e) Portable X-Ray Unit Yes______ No _____

9. Supportive Service

(a) Boilers/Sterilizer Yes______ No _____

(b) Ambulance Yes______ No _____

(c) Canteen Yes______ No _____

(d) Waste Disposal System

as per prescribe rules Yes______ No _____

(e) Blood Banks Yes______ No _____

(f) Pharmacy (In-house) Yes______ No _____

(g) Physiotherapy Yes______ No _____

(h) No. Of Operation Theatres Yes______ No _____

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10. Cardiological Facilities

NON INVASIVE

2D-ECHO Yes______ No _____

TMT Yes______ No _____

Other (Specify) Yes______ No _____

INVASIVE

Cath Lab Yes______ No _____

Cardie Surgery Yes______ No _____

OT Yes______ No _____

Other (Specify) Yes______ No _____

11. Hameodialysis/Urology/Urosurgery/Nephrology/Renal Transplant:

(a) Whether the Hospital has inhouse Urologist Yes______ No _____

(b) Renal Transplantation Surgeon Yes______ No _____

(c) Certificate for renal Transplant from Competent authority Yes______ No _____

(d) Haemodialysis Unit Yes______ No _____

(e) Trained Paramedical Staff Yes______ No _____

(f) Nephrologists Yes______ No _____

12. TURP/LITHOTRIPSY Yes______ No _____

13. ENDOSCOPIC/LAPROSCOPIC SURGERY:

(a) Endoscopy Yes______ No _____

(b) Laparoscopy Surgery Yes______ No _____

(c) Back Up Open Surgery Yes______ No _____

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14. Orthopaedics :

(a) Whether the Hospital has Modular operation theatre For Orthopaedic procedures Yes______ No _____

(b) Whether having required Instrumentation for both Hip and Knee Joint replacement Yes______ No _____

(c) Facilties for Arthroscopy Yes______ No _____

(d) Facilities for Arthroscopic Surgeries Yes______ No _____

(e) C Arm facility Yes______ No _____

(f) Physiotherapy Unit Yes______ No _____

(g) X-Ray Unit Yes______ No _____

15. E. N.T. Essential Information

(a) Whether it has required Instrumentation for ENT Surgery and diagnostic Procedures Yes______ No _____

(b) Facilities for Nasal Endoscopy Yes______ No _____

(c) Facilities for reconstruction Surgery Yes______ No _____

16. OBSTETRICS & GYNAECOLOGY

Essential Information

(a) Whether the Hospital has Modular operation theatres for Obstetretic & Gynaecological procedures Yes______ No _____ (b) Whether having required Facilities for Laparoscopy Yes______ No _____ (d) Facilities for Laparoscopic Surgeries Yes______ No _____

(e) C Arm facility Yes______ No _____

(f) Physiotherapy Unit Yes______ No _____

(g) X-Ray Unit Yes______ No _____

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17. Neurology/Neuro Surgery:

(a) Barrier nursing for Isolation patients Yes______ No _____

(b) Facility for Gama knife Surgery Yes______ No _____

(c) Facility for Trans- Sphenoidal endoscopic Surgery. Yes______ No _____

(d) Facility for Steriotactic Surgery Yes______ No _____

(f) Facility of EEG Yes______ No _____

(g) Facility for (EPS) Electrophysiology study Yes______ No _____

18. Gastro Enterology/ G.I.Surgery Yes______ No _____ (a) Required instrumentation for G.E./G.I. Yes______ No _____

(b) Facility for Endoscopy- Yes______ No _____ Specify details

19. Ophthalmogy: Yes______ No _____

(a) IOL with Phaco- Surgery Facility Yes______ No _____

(b) Well equipped OT Yes______ No _____

(c) Laser Facility Yes______ No _____

CANCER HOSPITAL

Infrastructure & Tech. Details:-

(a) Names of Oncologist ________________________________ (with qualification)

(b) Onco Surgery Yes______ No _____

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(c) Whether it has required instrumentation For Oncology Surgery Yes______ No _____

(d) Facilities for Chemotherapy Yes______ No _____

(e) Facilities for Radio Therapy Yes______ No _____

(f) Radio Therapy Facilities Yes______ No _____ & Manpower shall be as per guidelines of BARC.

(g) In house Pathology/ Haematology Yes______ No _____

20. Paediatrics:

(a) NICU/PICU Yes______ No _____

(b) Paediatric Monitor Yes______ No _____

(c) Paediatric Ventilator Yes______ No _____

(d) 24 hours Back-up of power Yes______ No _____

(e) Paediatrician/Neonatologist Yes______ No _____

21. Whether hospital is GST compliant Yes______ No _____

(Enclose GST registration number/letter and other related documents)

22. Any other facilities (to be mentioned by the hospital) :

23. Agreed all terms & conditions specified on website: Yes______ No _____

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Other Information:

1. Income Tax returns for last three financial years: ________________

2. Service tax number/Certificate & PAN Number: ________________

3. Detail of Registration ________________

4. Details of the organizations who have empaneled with your hospitals. ________________________________

Please enclose copy of agreement with full particulars.

5. Whether Doctors are available during night time to attend any emergency or to

undertake operation? ____________________________________________

6. Copy of document required is to be enclosed.

7. If required separate sheet may be used to give details of the hospitals.

* Conditional offers will not be entertained from the applicant. ** Only applicable columns are to be filled by different applicant. *** Enclose the attested copy of relevant documents.

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UNDERTAKING

I hereby certify that all the information furnished above are true to my knowledge. I have no

objection to North Western Railway for verifying any or all the information furnished in this

document with concerned authority, if necessary.

Date:

Place:

Signature of authorized signatory

of organization

Office Stamp/Seal

NOTARY

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