Jammu, Oct 23: Jammu and Kashmir government has amended the J&K Civil Services (Medical Attendance and Allowance) Rules, 1990 and notified reimbursement ceilings vis-a-vis costs of artificial appliances in private hospitals.
The amendment has been made by the Lieutenant Governor in exercise of the powers conferred by proviso to Article 309 of the Constitution of India.
The notification issued by the Financial Commissioner (ACS), J&K Finance Department, Shailendra Kumar, on behalf of the Lieutenant Governor, has also redefined “family” for dependent benefits besides updating reimbursement ceilings for artificial appliances.
Under the amended rule 3, ‘Family’ will mean husband or wife as the case may be, and parents, sisters, widowed sisters, widowed daughters, minor brothers, children and step-children normally residing with the government servant and wholly dependent upon him or her including dependent brothers, dependent divorced or separated daughters and step-mother.
Explaining the clause, the amended rules specify that the members of the family “will be regarded as wholly dependent upon the government servant if they ordinarily reside with him or her and their total monthly income does not exceed Rs 9000 plus Dearness Allowance thereon as on the date of consideration.”
Expanding the list of reimbursable cardiac devices, the amendments notify the maximum ceiling limit for the reimbursement of cost of artificial appliances. The amendments also restrict reimbursement for treatment at premium private hospitals to the rates payable at AIIMS New Delhi.
Amendment to rule 6-A specifies that “in case treatment is taken in Apollo Group of Hospitals (Delhi, Chennai, Hyderabad, Bangalore, Kolkata), Escort Heart Institute, Delhi, Institute of Liver & Biliary Sciences, Hospital New Delhi and Jaslok Hospital Mumbai, the reimbursement for treatment in these institutions will be restricted to the amount which would be payable for such procedures at AIIMS, New Delhi.”
As per amended rules, the maximum ceiling limit for reimbursement of the cost of various artificial appliances for beneficiaries admissible under the J&K Civil Services (Medical Attendance and Allowance) Rules, 1990, in case of heart valve, Double Valve Replacement (DVR) will be Rs 1,10,500 while in case of Mitral Valve Replacement or Aortic Valve Replacement (MVR or AVR) it will be Rs 45,050.
In case of cardiac devices, for Single Chamber cardiac pacemaker without Rate Response limit will be Rs 34,840+ GST; with Rate Response Rs 44,928 + GST, for Dual Chamber Pacemaker Rs 83,200 + GST; Bi-Venticular Pacemaker Rs 1,95,000 + GST; Implantable Cardioverter Defibrillator (Single Chamber) Rs 1,75,786 + GST; Dual Chamber Rs 3,75,000 + GST; Combo Device (CRT-D) Rs 4,90,000 + GST; Aortic Stent Graft Rs 4,40,960/- + GST; Rotablator with Advancer Rs 49,920 + GST and for Rotablator Burr, it will be Rs 23,920 + GST.
In case of Intra Ocular lenses, for Cataract extraction with IOL with capsular tension rings (Cionni’s ring), limit will be Rs 12000; ECCE with IOL Rs 5000; Pars pla lensectomy Rs 10000; Penetrating keratoplasty with IOL Rs 3000; Phaco with foldable IOL Rs 9375; Secondary IOL implantation Rs 6000 and SICS with IOL Rs 714.
For Oxygen Concentrator limit will be Rs 45,000+GST; CPAP Rs 45,000+GST; Bi-Level CPAP Rs 68,000+GST and Bi-Level Ventilatory System Rs 1,05,000+GST.
In case of hearing aid, for Digital BTE, limit will be Rs 8,000; for Digital ITC/CIC Rs 9,000 and for Cochlear Implant Rs 5,35,000.
For Transtibial (Below Knee) it will be Rs 20,000; with silicone/PU liner Rs 37,000; with shuttle lock Rs 45,500; for Symes Rs 19,300; Partial Foot Rs 7,000; Trans Femoral (Above Knee) Rs 40,840 to Rs 69,640, depending on type; for Knee Disarticulation Rs 51,940; Hip Disarticulation Rs 60,300. Similarly rates have been notified for child up to 12 years.
For Partial Foot, maximum limit will be Rs 4,000; for Trans Femoral Rs 49,980 to Rs 78,780; Knee Disarticulation Rs 49,980; Hip Rs 60,300 and for Transtibial High End, it will be Rs 26,700.
For Trans Radial Passive, the limit will be Rs 10,000; Body Powered Rs 17,000; Trans Humeral Passive Rs 20,000; Body Powered Rs 28,000; Shoulder Passive Rs 30,000; Body Powered Rs 37,000; Externally Powered Below Elbow Rs 1,29,500/-, Above Elbow Rs 1,76,500/-, Silicone Finger Rs 7,000; Thumb Rs 8,000 and Partial Hand Rs 35,000 with separate rates notified for children.
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