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). There 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.
Under Secretary to the Government of India