r*Q /[

c8w No" ?0O?/II/6-

L /Psiiey

!iew !)elhi,

{I}.

General Managers, A,lI Indian I&aiLways ianciuding

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{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

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AF=-*-

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*.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.

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Estt'

1.

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***:'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.&

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