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Thursday, August 28, 2014

Revision of lists and rates of artificial appliances for CGHS/CS(MA) beneficiaries and general guidelines for eligibility criteria therefor

Government  of India
Ministry  of Health   and  Family   Welfare
Department  of  Health   and  Family   Welfare

Nirman  Bhawan,  New Delhi,
Dated   the  8th  July,   2014.

Sub:  Revision  of  lists   and  rates   of  artificial  appliances   for  CGHS/CS(MA) beneficiaries   and  general  guidelines   for eligibility   criteria  therefor.

The    undersigned     is   directed    to   state     that    the    rates     of   artificial appliances   were  revised   in  1997  vide  OM No. S-11011/5/95-CGHS-(P)   dated 25.6 .1997.   The   matter    of  revision  of rates   and   updation    of lists   of  artificial appliances   has   been   under    consideration   of this   Ministry  for  some  time.  The matter    has   been   examined   in  consultation    with   the   experts    in  Directorate General  of Health   Services  and   it has   been   decided  to  update    the  list  of the artificial appliances   and  revised   as  per  the  details   given  in  ongoing paras.

2.         Keeping  in   view the    various     categories   of  appliances,    the    lists    of artificial   appliances     have    been     categorized    as    per    the    following  three Annexure  and   rates    of artificial  appliances   will  be  as  per  the  Annexure-1,   II and  III to this  OM:

Annexure-I: This   contains   list, rates   and   specifications   of various    types   of Prosthetics (i.e.   Artificial   limbs)    like   prosthetics    for   lower extremity,   prosthetics    for   upper    extremity   (Annexure-I has been   divided into   Annexure IA, IB, IC, ID and IE according to type].

Annexure-II:  This   contains   the   list,   rates    and   specifications  pertaining  to the  orthotics  (i.e. callipers  &  braces)   including  lower  extremity, upper    extremity  and   spinal    orthotics.(Annexure-11   has   been divided  into  Annexure-IIA IIB  and   IIC].

Annexure-III: This   contains    specifications   and   rates    for items    related    to mobility aids.

3.              The    general     guidelines    for   admissibility    and    reimbursement    of expenses in respect    of appliances mentioned in Annexures-1, II & III will be as under:

(i).    Maintenance   Cost will be borne   by the beneficiary.

(ii).   The  appliances   will be  allowed for  re-issue  on  completion  of 5 years   in case   of  adults    and   2  years    in  the   case   of  children   except   motorized wheel  chair   and  tricycle.

(iii). Motorized wheel    chair    and    tricycle will   be   re-issued    after 5 years irrespective of age.

(iv). High    end    prosthetics/ appliances   will   be   reimbursed     only    to   the following category of Govt. Servants & their   dependent   family members subject   to fulfilling of other   criteria   :-

(a)  Govt. Servants & their   dependent   family members    participating at the State   level sport   activities duly certified by the competent Sports   Authority.

(b)   Upper   Age limit   for the   sophisticated prosthetic appliances will be 45 years.

(c)  Military   or    para-military     personnel   duly     certified    by    their respective Medical   Boards   that the person    has   sustained    injury while   on field duty or undergone amputation because   of injury sustained while performing such   duty.

(d)  The  reimbursement will be  made   within   the  ceiling  limit  fixed  for such   appliances  beyond which  the  beneficiary will bear  the  cost

(v). For    admissibility of   reimbursement,    the    appliances     need     to    be prescribed by a Professor/ Senior   Specialist or Specialist   of equivalent rank working in   any Govt.   Hospitals   in   the    specialties   of Physical Medicine   and    Rehabilitation   (PMR) or   Orthopaedic   surgery.      The prescription   should   be in generic   name   and not by proprietary name.

(vi). Prosthetic components   and   Orthotic joints    used   in appliances   should have      BIS/ CE      (Europian)     Certification     for      the      purposes      of reimbursement      and       fabricated       by      firms        having        qualified Prosthesist/ Orthotists.

(vii).   Keeping  in   view,   the   physical  growth   into   consideration,   individuals upto    12 years of age will  be  considered  as children  for  the  purpose   of these   guidelines   in  general.  However,   in  order   to  rationalize the  rates for  some   of the  items,   specific age  group   has   been   mentioned against the  individual  items   in  Annexure-I  and  Annexure-II,   based   on  the  size of the  appliances.

(viii)T. here may   be  certain    items   which   are  not   included   in  Annexure,  but may   be      prescribed      by      qualified      Government      Rehabilitation Specialist/Orthopaedic     Surgeon,   (not  below   the   level  of  Consultants), depending  on  individual   disabled  patient's   requirements  for  example disability car  gadgets.    In such cases, items   costing   below Rs.50,000/• can  be     purchased      with     three      quotations      as     per     prescribed specifications     with     the     permission     of    HOD   of    the     concerned departments.   For items   costing above   Rs.50,000/-    prior     permission will   have  to   be   obtained   from   Additional   Directors,   CGHS  of  the concerned  city  or  concerned  DDG in  the  Dte. GHS looking   after   CS(MA) Rules,   on   the   basis    of  three    quotations   and    approval   of  Technical Standing  Committee.

(ix).   The   artificial   appliances   should   be   procured  from   any   Government Undertaking/   Authorised  Alimco dealers,  N.G.Os approved  by  Ministry of  Health  &  Family Welfare/and  private  manufactures.   It   should   be certified by         the       prescribing         Government         Orthopaedic Surgeon/Government  Rehabilitation  Specialists  (PMR) to the  effect  that the appliances are  as  per  Specification  and  working  satisfactorily.

(x).     the list of items and rates will be revised every 5 years.

(xi).    Reimbursement   of items   in  the  enclosed  list  will  be  made   by  HODs of the   departments  and   CGHS  in  case   of  Pensioner   CGHS  beneficiaries, etc.

4.         This   OM supersedes   all earlier   orders   issued   from time to time under CGHS/CS   (MA) Rules,    1944   on the   subject    for allowing reimbursement    in respect   of artificial appliances for CGHS/CS (MA)   beneficiaries.

5.         This  OM will come  into  effect  from  the  date  of issue   and  will be  valid  till revision   of the  rates   after  five years.

6.          This issues    with the approval of Secretary (H&FW) and concurrence of
Integrated Finance Division.

(Ravi  Kant)
 Under  Secretary  to  the  Government  of India


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