r*Q /[
c8w No" ?0O?/II/6-
L /Psiiey
!iew !)elhi,
{I}.
General Managers, A,lI Indian I&aiLways ianciuding
'"ilW
{iOVEI'ArrSIV]'fi f{lf $F nT.{nl^f{ MtrNIS?"I{Y $F' R.AI!"VVAYS {FtAILw.eY $O.Pi.}r$}
trlUs & R.DSO.
,
Sub: - Guidel.ines rcgard.ing Cqch"lear Imrgllantation ' bencf,ieiaries.
Ref:- Ministry of I{ealth & famity x?.06.2069.
in non-SRailway Etrospitals for Railway
We!.fare'e lettes I{o. 6-469/2003-CGIIS/R&H
dated
t *:k***
A copy of Ministry of Healih & Famiiy'Welfare's ietter No. 6-469/2O03-CGHS/R&H dated 12.06"2009 is enclosed herewith. Th'e competent authority in the Ministry of Railways has decided to adopt the policy of QGi{S mutatis-mutandis for Railway beneficiaries also in supe.rcession of existing policy of Railways dated 31,12.2009. -Flowever, Medical Board for asseissing the suitability of the beneficiary f,ar the implant will comprisc of MDICMS/MS as head and one l,)g'l' Strrccialist with onc Sr. Ph5isician/Sr- Surgcon as members of thc Committee. AIl otirer provisions of CGlls.guiclclincs ivrtl be a
3)
These instructiorrs will be appiicable from the date.of its issue.
'i'his
Directorai.ii
issues with the concr-lrrenccof Flina
Ministry of Railways.
s
Joiut No. ?OS?/H/5-L/Foiiay Copy forwarded to;-
ffi
k
Sirector/flealth, X{ailway Bonrd.
\0J-.Of .ZOfe. Xlatee3;r^:Retrhi, W
t\\.::i::.
',iiiffi
riS"-
t.
u. tII.
'l'he
Chief irri,rstnof[)irector, A11Indian Railwa-vir:rclurlingI]{Js & }{i)SO.
F'A&CAO, All Indian l{ailway including PUs & ltDSO.
Chief PersonnelOf{icer.All Indian Rail*ay including PUs & I{!)SO. \\ "N
B*
J$int
\
\i(\N No"1#oo?/Hlg-1'Ro{lcy {l[].
Director/Health, Railway Fqrard
Ncvcx]elhi,I]ated:- rSlor.zoro.
Cerpy forwarded to:I ll.
lfhe Principal lJirec{or o&Sudit, All Indian Railwa.vincluding PUs &.RDSO.. Dy, Comptroller an& Additor Generai of Inclia {Railways), Room No. 224, Rail Bhawan, New Delhi.
, Sr.l.o*"
Frar Firsancial .
@
Cornrni
Nafional Federation of Indian Railwuymen (N.F.I.R) 3, Chelmsford Road, New Delhi.
No. I/I"2/Part IV Copyforwurded to the Generul Secretaries of affiliated Unions of NFIR for information.
sieemer/XRailway 8oard.
w ffi
r.*ffi
F, No: 64S9I2003-C0H$R&H
Govermnrersfof Jmdia fif;inist4rof l'feafffi p;''ls{FentNy Welfare frepartmenf of HEarffi & Family Welfare Nirman Bhawan, Maulane Azad Road filew Delhl llA 108 DalE;lt' June,2009
a9
o F E t cl',- M.E AtLILAJN p u.M Sgbtect The undersignedis directed to state that the Ministry of Health & Family Wetf,arehas been recelvedrequestsfrom CGH$ heneflciariesand beneficiadesunder to be givgn requestingfor permis_sion Central$ervices(MedicalAttenbance)Rules,191P., for a dependantiamily memberto undergqcochlearimplant$urgary. Each requestfor consideiedion merits'-of each case and Fermissiongrantedby the CentralGovemment Haalth$chemein each case. This was mainlybecausethere were no guidelineslorfgr cdnsideringrequestsfor cochlearimplantsuigery, The Ministry of Health& faftily Weltare,tfrerefirre,had the matterconsideredthe matterby'a Committeeof specialists and it has been decidedto permitthe beneficiariesunderCGHS and Central$ervices (Med'rcalAttendance)Rules, 1944 undergo cochfearimplant surgeries, as per the guidelines outlinedbelow:
' 1.
cu,pEufirFFFg8 cggHtEAStllELu[rg.ufiGFF.v
Selectionctnertafrtr cagfileg:imolant: (i)
I
BlL,S. N' H.loss) FrelinquallV de{ children(geverd lo profound
(a)ffi,'fliTts"ffi;:til fli'S:1"1ru:3 fJf-lTffi,.nTffivfJ; may be consideredat highdrage also on a caseto casebasis;
'
oftrial 6months lor *fi.1$ffi5T,:J-HlJll[.iffi:fl#i:-1{-r
i
(c)
No menhalretardation;
, i
td)
No activemiddleear cleftdisease. Ferforationof the TM should be closedat leastthreemonthspior to implantation;
i
(e)
l.lo cochlearaplasiaandI or agenesisofcochlearnerve;
i
(0
and No retrocochlearlesionor centraldeaftesq;
s
@
(g) . Gqodfamitysupportfor postop rehabilitation.
1r .l
'
(ii)
Post-lingually deafcandidates (B / L profounds. N. H. loss) (a)
Thele shoutdbe no appreclsbb benefitfrom hearingaids
ears);
{both
(b)
No activemiddleear cleftdis6ase;
(c)
Perforationof the TM should.berepairedthreernonthspriorto the implantation;
(d)
Deafnessshouldbe due to cochlearlesions;and
'i.
(e)
lorJ meningitic labyrinthitisosscificansof the cochtea is a contraindication. However, cases- like post iniiarr,ratory ossification of. cochlea, cochrear dystrophies and cochlear '. otosclerosiewith visine ierity*pnru. shadowin MRI are relative indicationsandcan be dilne iln caseto caseo.ri*.
2"
Tvpaof imnlants: only mutti-channer cochrearimplantduly approvedby appropriateauthority sfiouldbe recommended.
3.
cochlearirnplantsurgeryshouldbe ailoweg in,Governrnent hospitals /' -_qnly postoperatiwrefrauirit"r{on, These S,ljtl,,19vifs .proper. centres *"t'=: ' shdutd navewelltrained speech neraprsl rerated to *"nr*rii*pr"iigi.mlursgment forcochrear imprant surgery wilrbepermitted lf ]onryaftg the. ll requesthas beenapproved -"" and;' recorn*-*njJ" by a standingcornniittee, cornRrising ofthefolloifing,-I ( 1 ) AddlDG,cGH$/ - maybe) Chairnan ?pg (y) (qsthecase r%
(2) (3) (4)
r_.'n6nbitat "l-l?P,ENr,Dr.R.rvr. $afdariuns nosditai 1-|99, El!f,
HOD,ENT,LHMC-& dmtS. n HgspitaJ
Member Mernber Member
ueaccorynanieE bycomprete crirffi Ini:Ttrij*::i,,H. ilg,l5_:lLoyld d etails andreport orrgr jl'il,Tl rit il;;-d;;;";*; gvg ili",il1"r?ifrl-r;;lHl from two
ENT speciarisis ;i--G;*rnment undertaking cochrear implant .Hospitars $urgeryaboutindications forcoctrtear imprant $urgery. ,
-4*
@ 4. {a}
Audiolooical: (1) (2) (3) (4)
O)
',
"!. Radiolooicat:
(1) (2) (c)
OAE BERA/ ASSR lmpedence(in chitdren) Audigram/ Aidedaudiogram
HRCT-ternporar bonefor bonycochleaand middleearcleft; 3D NRIfor membranous.cochlea, NeuralBundleanOUrainl'anO
lQ / Psychiatricevaluationin childrenwith prelingualdeafness.
Cqifr.ngRate; rate for cochlearimplantshall be Rs. 5,35,000/-(Rupaes -:..Five ,Tha.ceiling lakh^thirty five thousandonly) fir reimbursementof cost of iocirtu"r implantwith12 channelits t 24 etectr6ieswith behindtne Carspeechprocessor. The best resultsare achievedif cochlearimplantstake placebetween -p"tmit the age of 1 * 5 years. Hence, it r$, ilrere?ore,propoied-to reimbursementin a graded manner. In the pre-rrhjuai deaftess, total reimbursementof the ceiling rate or actuals,whiihever"is les$,tar circrrpar irnplantwitt be alowed respectof imptanb canied out on ihttdren aged i1 BS**n-l and E years. For chirdrenbetweenthe age of 5 and 10 years,d0yo glthe ceilingratefor implantwillbe reimbursed.Foichltdranabovethe igJoi 10years,but below10 yearsof age.onlyF0yoof the rate for ne imitant willbe reirnbursed "eiiing
OnlyUnilateral imptantation willbe allowed.
vAs cochlearimplant is a planned.surgery, priorpermission hasto be obtalned befarethesurgery.surgery is u-ndertaXen. p. - PensionerGGH$ beneficiaries and servingemproyees, who are cGH$ beneficiariesl sYbp,l ttreir requests p*tri$ion hr Tay cochlear implantto the {or Director, CqHs' centralGovernrnent empoydes wno.re Oeneficiaries underCentral
'
4$ al
I
-*
AF=-*-
I L*'
*.v:1T;H11,1ffiffitf,iilfl:frff't"# 1s44' .otHe"m Rures, '##;;' rntteniance) se( ""---"'
S:fffl il|S"i ffL"ilno"o' !F*:ffi NerrDethi110108'
r issue of the offrce of d"t* the take effect from These instructions
I.
FAl200g FN200( .. ^::-,,.rr r*rn.4g4lAS A*4IAS . rr_ r^re,rrt.-. 4g4tAs & FN200g j!,-.,.,^r,.6 ..nncr.rrrence r - their Dy. No: vr vide (rr lFD, rr of concurrenqs This issues with the--j -F
vlernorandum. {rl**or"ndum. 10.
JanuarY,zooa' ili*otr'*l+c
/Ip*^q
tl-.'tr*dt*
lnclta the to $ecretary """Ti'J,l'llb6'drCet Deputy
To
lent of India "'"'of GovernmetJn'nJ' AllMinistries.{P*fl**ent$
1.
liqd#I';ru;tgl3i::^ ;. DiJ;;i"i-eHs' r New 1 " fllffil,*ffii#[T-?i"Hg*tr"ioiceHs ,*-a4n nhawa', Bhawan' Dte'GH$'Nirman rnii'i'i$jr*-t -:,?[3'-"Jl[orr-,,,
F.
cci-rs Deslt'llDesx wdttara Min.of Health& Family Delhi sectons, lv Estt. ffi t I I Estt' I ET,adilii*;ibG-cHs
6.
'
Estt'
1.
!t
***:'i g. t'i$tllftTil'i#"fiftfulflffi' Naw r c]"ar sheh Road, Sabha' Lox. 1'0' RaiYa ii '
suPrernt Registrar' Delhi
14 ?f; t'-*'*ry Priy"l"-T*:ru*yl*:**' ilil
"Tr;rining. weHare - Personnel & Family 12, U.P.s'c'-. . " rrrrinic,rrv Health of ry*Iln& 13. iinanc*Diviston'.Ministry "t .H?"-ltL.&
* T: Fffiffi$g'ff'tff I Hffff t1e' :ilb'sliomar
lf
l^.,*,(rcM),10 zata Bahad:],
lTllil,%:Hliitl'l';o'"' ::' 3;$i,5fJ li tttri,-lf,: wetrare &Farnilv iltIt*: bq Mnistry.of,H31ltn the in -' ?:Hi,""s t'nL""ndu rYrrFrrrv' b*^t:YL:::/ Deskg r thg-'ult::Officers that All ]]il'. ti*'"quust NirsaL y2?'t r'iic, A$tr#Ai'ffi^,"l'1f;, uPloaded !ntlttl[tgll-TltJfi? ' 24' 28'
Offi"* Orderfolder Guardfile