Reimbursement of cost for procurement of Nucleus-7 sound Processor kit: Railway Board

Reimbursement of cost for procurement of Nucleus-7 sound Processor kit: Railway Board Order dated 20.06.2022

GOVERNMENT OF INDIA (भारत सरकार)
MINISTRY OF RAILWAYS (रेल मंत्रालय)
RAILWAY BOARD (रेलवे बोर्ड)

No. 2021/H/6-4/02

New Delhi, dated:.20.06.2022

Principal Chief Medical Director(s)
All Indian Railways,
(Including PUs & RDSO)

Sub: Reimbursement of cost for procurement of Nucleus-7 sound Processor kit—reg.

On a clarification sought by one of the zonal railways regarding the number of times reimbursement of cost of wearable component for the purpose of upgradation &/or replacement is allowed in the lifetime of a patient after undergoing cochlear implant etc., the matter has been examined in consultation with Ministry of Health & Family Welfare (MoH&FW). In this regard, a copy of clarification sought by this Ministry & reply thereto received from MoH&FW vide their OM No. S.11030/39/2022-ECHS dated 18.04.2022 are enclosed for information and compliance.

The above clarification is being issued in consultation with Finance directorate. This has the approval of DG(RHS).

(This disposes of the reference received from ECoR’s letter No. ECoR/BBS/Med./Reim./Cochlear Implant/D.Mishra/1042 dated 18.10.2021)

Encl- As above.

(Dr. K Sridhar) /(डॉ के श्रीधर)
Exe, Dir., Health /का.नि.स्‍वा.(स)
Railway Board/रेलवे बोर्ड

File No. S.11030/39/2022-EHS
Government of India
Ministry of Health & Family Welfare
Department of Health & Family Welfare
(EHS Section) SUT

Nirman Bhawan, New Delhi
Dated 18th April, 2022.

OFFICE MEMORANDUM

Subject: Reimbursement claim of Dipsikha Mishra, Sr. Clerk, aged 43 years under control of PCPO/ECoR/BBS for procurement of Nucleus-7 sound Processor kit-reg.

The undersigned is directed to refer to Ministry of Railway, Railway Board’s OM no. 2021/H/6-4/02 dated 02.03.2022 on the subject cited above, and ‘to say that as per the provision made under MoHFW OM dated 12.06.2009 (copy enclosed), 50% of the cost of the wearable components, e.g. Speech processor, microphone etc. (excluding chords, batteries) for the purpose of up-gradation and/ or replacement due to wear and tear may be allowed, after a period/interval of three years, subject to the advice of two Government ENT Specialists and recommendation of STC.

The related bills may be regulated accordingly.

(Rajender Kumar)
Under Secretary to the Government of India
Tel No. 011-23061778

Encl. As above.

To
Ministry of Railway
Railway Board,
Dr. K. Sridhar, Exec. Director, Health (G)
Rail Bhawan, Raisina Road, New Delhi.

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Government of India
Ministry of Health and Family Welfare
Department of Health & Family Welfare
Nirman Bhawan, Maulana Azad Road
New Delhi 110 108

F. No: 6-469/2003-CGHS/R&H

Date: 12th June, 2009

OFFICE MEMORANDUM

Subject Reimbursement of the cost of cochlear implant to beneficiaries under CGHS / Central Services (Medical Attendance) Rules, 1944.

The undersigned is directed to state that the Ministry of Health & Family Welfare has been received requests from CGHS beneficiaries and beneficiaries under Central Services (Medical Attendance) Rules, 1944, requesting for permission to be given for a dependent family member to undergo cochlear implant surgery. Each request for considered ‘on merits’ of each case and permission granted by the Central Government Health Scheme in each case. This was mainly because there were no guidelines for for considering requests for cochlear implant surgery. The Ministry of Health & Family Welfare, therefore, had the matter considered the matter by a Committee of specialists and it has been decided to permit the beneficiaries under CGHS and Central Services (Medical Attendance) Rules, 1944 undergo cochlear implant surgeries, as per the guidelines outlined below:

GUIDELINES FOR COCHLEAR IMPLANT SURGERY

1. Selection criteria for cochlear implant:

(i) Prelinqually deaf children (severe to profound B/L, S. N. H. loss)

(a) Age group between 1 to 16 years. However. children using hearing aids and getting auditory training from age 1 years of less may be considered at higher age also on a case to case basis:

(b) No appreciable benefit from hearing aids after 6 months of trial with hearing aids. No speech formation seen;

(c) No mental retardation:

(d) No active middle ear cleft disease. Perforation of the TM should be closed at least three months prior to implantation;

(e) No cochiear aplasia and / or agenesis of cochlear nerve;

(f) No retro cochlear lesion or central deafness; and

(g) Good family support for post op rehabilitation.

(ii) Post-lingually deaf candidates (B/L profound S. N. H. loss) |

(a) There should be no appreciable benefit from hearing aids (both ears);

(b) No active middle ear cleft disease,

(c) Perforation of the TM should be repaired three months prior to the implantation:

(d) Deafness should be due to cochlear lesions; and

(e) Post meningitic labyrinthitis osscificans of the cochlea is a contraindication. However, cases like post inflammatory ossification of cochlea, cochlear dystrophies and cochlear atosclerosis with visible perilymphatic shadow in MRI are relative indications and can be done on case to case basis.

2. Type of implants:

Only multi-channel cochlear implant duly approved by appropriate authority should be recommended.

3. Implant Centres and Standing Committee:

Cochlear implant surgery should be allowed only in Government hospitals / Centres having proper post operative rehabilitation. These centres should have well trained speech therapist related to cochlear implant.

The reimbursement for cochlear implant surgery will be permitted only after the request has been approved and recommended by a standing committee, comprising of the following:

(1) Addl DG, CGHS / DDG (M) {as the case may be) … Chairman
(2) HOD, ENT, Dr. R. M. L. Hospital .. Member
(3) HOO, ENT, Safdarjung Hospital .. Member
(4) HOD, ENT, LHMC & Smt S.K. Hospital .. Member

The request for cochlear implants should be accompanies by complete clinical details and report of relevant investigations as below and independent opinion from two ENT specialists of Government Hospitals undertaking cochlear implant surgery about indications for cochlear implant surgery.

4. Basic pre-op Investigations for Cochlear Implant:

(a) Audiological:

(1) OAE
(2) BERA/ASSR
(3) Impedence (in children)
(4) Audigram / Aided audiogram

(b) Radiological:

(1) HRCT temporal bone for bony cochlea and middle ear cleft;
(2) 3D NRI for membranous cochlea, Neural Bundle and brain; and

(c) IQ/ Psychiatric evaluation in children with prelingual deafness.

5. Ceiling Rate:

The ceiling rate for cochlear implant shall be Rs. 5,35,000/- (Rupees Five lakh thirty five thousand only) for reimbursement of cost of cochlear implant with 12 channels / 24 electrodes with behind the ear speech processor.

The best results are achieved if cochlear implants take place between the age of 1 — 5 years. Hence, it is, therefore, proposed to permit reimbursement in a graded manner. In the pre-lingual deafness, total reimbursement of the ceiling rate or actuals, whichever is less, for cochlear implant will be allowed in respect of implants carried out on children aged between 1 and 5 years. For children between the age of 5 and 10 years, 80% of the ceiling rate for implant will be reimbursed. For children above the age of 10 years, but below 16 years of age, only 50% of the ceiling rate for the implant will be reimbursed.

50% of the cost of the wearable components, e.g. Speech Processor, Microphone, etc. (excluding cords, batteries) for the purpose of up-gradation and / or replacement due to wear and tear may be allowed, after a period of three years, to be considered on the basis of advice of two ENT surgeons of Government sector and on the recommendations of the standing committee.

6. Only Unilateral implantation will be allowed.

7. As Cochlear implant surgery is a planned surgery, prior permission has to be obtained before the surgery is undertaken.

8. Pensioner CGHS beneficiaries and serving employees, who are CGHS beneficiaries, may submit their requests for permission for cochlear implant to the Director, CGHS. Central Government empioyees who are beneficiaries under Central Services (Medical Attendance) Rules, 4944, may submit their requests for permission, to MG II Section, Directorate General of Health Services, Nirman Bhawan, Maulana Azad Road, New Delhi 110 108.

9. These instructions take effect from the date of issue of the Office Memorandum.

10. This issues with the concurrence of IFD, vide their Dy. No: 494/AS & FA/2009 dated the 24th January, 2008.

(R. Ravi)
Deputy Secretary to the Government of India
(Tel: 2306 3483)

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GOVERNMENT OF INDIA (भारत सरकार)
MINISTRY OF RAILWAYS (रेल मंत्रालय)
RAILWAY BOARD (रेल बोर्ड)

No. 2021/H/6-4/02

New Delhi, dated: 17.02.2022

OFFICE MEMORANDUM

Sub: Reimbursement claim of Dipsikha Mishra, Sr. Clerk, aged 43 years under control of PCPO/ECoR/BBS for procurement of Nucleus-7 sound Processor Kit—Reg.

The undersigned is directed to refer to the case of Mrs. Dipsikha Mishra, Sr. Clerk, ECoR/BBS relating to upgradation of speech processor to Nucleus-7 Sound Processor at the cost of Rs. 6,20,550/- on the recommendation of ENT specialists of AIIMS, BBS. The undersigned is further directed to draw the attention on the provisions of CGHS guidelines which has been adopted for Railway medical beneficiaries mutatis-mutandis and to say that as per laid down provisions of CGHS 50% of a wearable component i.e. speech processor, microphone etc. for purpose of upgradation and/or replacement due to wear and tear may be allowed after a period of three years. In this case, the employee has got the speech processor upgraded after a period of more than 03 years. However, the cost of upgraded speech processor is more than the fixed cost of cochlear implant as decided by CGHS.

In view of above position the undersigned is directed to seek clarification of CGHS welfare on the following points:

1. Number of times reimbursement of cost of the wearable components for the purpose of upgradation and/or replacement is allowed in the life time of patient after undergoing Cochlear Implantation.

2. The Standing Committee for recommendation for cochlear implantation surgery has been revised by Railway Board and mentioned in Board’s letter no. 2007/H/6-1/Policy(1) dated 05.01.2016, but no committee has been defined specifically in Board’s letter for recommending the change of wearable component for the purpose of upgradation and/or replacement due to wear and tear.

The above has the approval of Executive Director/Health, Railway Board who is in the rank & pay of Joint Secretary, Railway Board.

(Dr. K Sridhar) /(डॉ के श्रीधर)
Exe, Dir., Health /का.नि.स्‍वा.(स)
Railway Board/रेलवे बोर्ड

To
Government of India
Ministry of Health & Family Welfare
Department of Health & Family
(C.G.H.S. (P) Wing)
Nirman Bhawan, New Delhi.

Source: Indian Railways