13. Instruction of the Ministry of Health, Govt. of India on the
procedure to be followed regarding medical treatment under Indian System of
Medicine and Homoeopathy in respect of Central Government servants:
Instructions to the State Governments for adoption: -
I am directed to say that in accordance with the Government of India decision No. 13 below Rule 2 of the All India Services (Medical Attendance) Rules, 1954, the State Governments are competent to recognise Unani or Ayurvedic Hospitals for the purpose of treatment of All India Services Officers serving in connection with the Affairs of the State. The Government of India (Ministry of Health and Family Planning) have issued orders/instructions regarding the procedure to be followed regarding medical treatment under Indian System of Medicine and Homoeopathy in respect of Central Government servants vide their O.M. No.29/16/71-MA dated 14-09-1972 (copy enclosed).
2. It has been decided that the provisions contained in the Deptt. of Health’s O.M. referred to in para 1 above may also be adopted in respect of the members of All India Services.
3. The authorised Medical Attendant in respect of members of the AIS will have the same meaning as mentioned in para 2(i) (a) of the Ministry of Health and Family Planning O.M. No. 29-16/71-MA, dated 14-09-1972, referred to in para 1 above, and also under rule 2(a) of the AIS (Medical Attendance) Rules, 1954.
4. I am to request that the contents of this letter may be brought to the notice of the members of the Service working under the State Government.
(i) Copy of Deptt. of Health letter No. 29-16/71MA, dated 14th September, 1972.
1. Reference is invited to this Ministry’s Office Memorandum No.F. 28-26/61-HI, dated the 6th November, 1961 reproduced as Government of India decision No. 5 at page 11 of the Compilation of Central Services (Medical Attendance) Rules, 1944 and orders (1964 edition). It was clarified under para 2 that under the Medical Attendance Rules, modern system of medicine only is recognised and other systems of medicines such as Ayurvedic, Unani, Homoeopathy amount covered by these rules, and that Ayurvedic etc., hospitals are not recognised for the purpose of aforesaid orders even though some of the State Governments have recognised such hospitals for the treatment of their own employees. This decision was based on the policy of Government according to which Allopathic (Modern) scientific medicine should continue to be the basis for the development of the National Health Services in the country. The above mentioned policy decision has recently undergone modification according to which the Union and State Governments have been directed that Allopathic, Indian and Homoeopathic Systems of medicine should contribute towards the development of the National Health Services in the country.
2. The question of giving effect to the aforesaid revised policy decision in so far as medical attendance and treatment of Central Government servants and members of their families are concerned under the provisions of the Central Services (Medical Attendance) Rules have been under the consideration of the Government for some time past. It has now been decided as follows:-
(i) Authorised medical attendant for the purposes of these orders within the meaning of Rule 2 of the Central Services (Medical Attendance) Rules, 1944, will mean -
(a) In respect of a Government servant who belongs to a Central Service Class I, or whose pay is not less than Rs. 500 per mensem, Class I officers belonging to Ayurveda, Unani, Sidha and Homoeopathic Medical Services of the State/or Central Government or any other qualified medical officer, appointed by the Government, to attend its officers in the district;
(b) In respect of a Government servant not belonging to a Central Service, Class I whose pay is less than Rs. 500 per mensem, but more than Rs. 150/- per mensem, a Class II Gazetted Officer of the Department of Indian Medicine or Homoeopathy of a State or Central Government, or any other qualified Medical Officer, appointed by the Government to attend its officers in the station;
(c) In respect of any other Government servant, the physicians-in-charge of Government, Government aided Municipal and Panchayati dispensaries of Ayurveda, Sidha, Unani and Homoeopathic systems of medicines and/or any other qualified medical officer, similarly appointed.
N.B.: The term ‘qualified’ would mean in the case of Ayurveda, Unani and Sidha, persons possessing recognised medical qualifications as included in the II, III and IV Schedules of the Indian Medicines Central Council Act, 1970. As far as Homoeopathy is concerned, it would include the recognised medical qualifications as notified in the II Schedule of the Homoeopathy Central Council Bill, 1971.
(ii) Rates of fees for purposes of re-imbursement:
(a) Class I Officers belonging to Ayurveda, Unani, Sidha and Homoeopathic Medical Services of the State or Central Government of any other medical officers of equivalent status appointed by the Government....................Rs. 16
(b) Class II Officers of the Departments of Indian Medicine and Homoeopathy of a State or Central Government or any other medical officer of an equivalent status appointed by the Government........... Rs. 3.
(c) Others.....................Rs 3.
Provided that in respect of medical officers of State Governments who are not allowed to receive any payment, no fees would be reimbursable.
NOTE:- The fees prescribed in clause (a) and (b) above will be payable for consultation at the consulting room of the authorised medical attendant or at the residence of the patient.
(iii) List of admissible medicines for the purpose of reimbursement: Ayurveda, Sidha, Unani and Homeopathy.
The list of medicines in these systems approved for the purposes of reimbursement with indication of maximum prices against each medicine is given in Annexure I. In this Annexure, lists of medicines have been drawn up in three categories viz.
(a) Costly medicines and treatment like panchakarma therapy which may be prescribed only by class I officers or a doctor of equivalent rank;
(b) General medicines which may be prescribed by all authorized medical attendants, and
(c) Restricted medicines which may be deemed to be medical tonics having curative properties which may be prescribed only by a Class I and Class II Officer or by a doctor of equivalent rank.
The cost of medicines will be reimbursed on the basis of the prices indicated in the catalogues of the pharmacies concerned.
The cost of medicines indicated in Annexure I will however, be applicable in the case of medicines manufactured by private practitioners, who may be nominated as authorized medical attendants for the propose of these rules.
3. Lists of approved pharmacists Druggists/Ayurveda, Unani, Siddha and Homoeopath, Central Government servants should purchase Ayurveda/Unani/Siddha/Homeopathic medicines prescribed by their Authorised Medical Intendancies from the pharmacies or concerns or their authorized dealers indicated in the list attached (ANNEXURE-I).
4. With a view to ensuring that the incidence of expenditure on medical reimbursement in the Indian system of medicine and Homoeopathy does not tend to be unduly heavy, it has further been decided that, all claims pertaining to restricted and costly medicines and cost on therapy like panchakarma preferred by the Central Government employees in these systems should be required to be countersigned by the State Directors/Officers in-charge of Indian Systems of Medicine or Homeopathy Department of the State/Administrative or Central Government concerned. In cases where no Indian Systems of Medicine or Homoeopathy department exist, such claims may be countersigned by the Directors of Health Services of the State concerned or by any other of Indian systems of Medicine/Homeopathy Branch in the Ministry of Health and Family Planning (Department of Health) as may be authorized for the purpose. In other cases, the Controlling authorized will be empowered to dispose of claims as provided in the Central Services (Medical Attendance) Rules in accordance with these orders.
5. These orders will take effect from the 15th October, 1972. These orders are also applicable to Central Government servants and member of their families stationed in or passing through Calcutta.
6. In so far as persons serving in the Indian Audit and Accounts Departments are concerned, these orders have been issued after consultation with the Comptroller and Auditor General of India.
ANNEXURE - I
ANNEXURE - II
14. Instruction of the Ministry of Health, Govt. of India on reimbursement of expensed incurred in connection with the procurement of artificial appliances in respect of Central Government servants: Instructions to the State Governments for adoption:
The Govt. of India have decided to extend the provisions contained in the Ministry of Health and Family Welfare O.M. No. 14025/31/79-MS, dated 26-9-80 (copy reproduced below) regarding reimbursement of the cost of artificial appliances to the members of the All India Services serving in connection with the affairs of the Union. The State Govt. have been requested to adopt these orders in respect of the members of the All India Services, serving in connection with the affairs of the States.
[G. I. DP & AR No. 11023/14/80-AIS (III), dated 21st July 1981.]
(i) Copy of the letter No. S. 14025/31/79-MS, dated the 26th September, 1980, from the Government of India, Ministry of Health & Family Welfare.
1. The undersigned is directed to invite a reference to para 7(b) of the Ministry of Finance office Memorandum No. 21 (2)-EV(B)/62 dated the 17th April, 1963 (copy enclosed) which provides for reimbursement of expenses incurred in connection with the procurement of artificial appliances where necessary and justified to those covered under the CS (MS) Rules 1944, by the Ministries/Heads of Department in consultation with the Department of Health. The question of rationalisation and streamlining of the existing procedure involved in the reimbursement, of the expenses incurred on artificial appliances, its replacement, repair and adjustment has been under consideration of the Government of India. The question of drawing up a list of such artificial appliances whose cost would be reimbursible to those covered under the CS (MA) Rules 1944, has also been under consideration of the Government of India and it has now been decided as under:-
(1) The list of artificial appliances whose cost would be reimbursible to the government officials and the entitled members of their families covered under the CS (MA) Rules, 1944 is enclosed.
(2) The expenses incurred on the purchase, replacement, repair and adjustment of these appliances may be reimbursed to the government employees when these are certified essential by a specialist in the concerned speciality in the hospitals recognised under the CS (MA) Rules, 1944. The repairs and adjustments where necessitated under the advise of the medical specialist should be got done by the Rehabilitation Department of the Medical colleges and hospitals, Artificial Limb Centre, Pune and such other centres and organisations recognised for this purpose by the Central or State Government.
Where, however, under the advise of the Medical specialist the artificial appliance is to be repaired/adjusted, it has to be ensured that the cost of repairs/adjustment of appliance is less than the cost of replacement thereof.
2. It has also been decided by the Government to delegate power to all Ministries/Heads of Department to allow reimbursement of expenses incurred on the procurement/adjustment/repairs of these appliances subject to the condition that these have been done when they are certified as essential by a concerned specialists in the government/recognised hospitals under the CS (MA) Rules, 1944 and have been purchased/repaired from the Rehabilitation Department of the Medical Colleges and Hospitals, Artificial Limb Centre, Pune, and such other centres and organisations recognised for the purpose by the Central or State Government.
3. These orders will, however, not be applicable to the Artificial appliances which are covered under the specific orders of the Government of India e.g. Heart Pace Maker and replacement of its pulse generator and cost of replacement of diseased Heart valves vide Ministry of Finance O.M. No. 22(3)EV(B)/76, dated 18-06-1976, O.M. No.22 (3)-EV(B)/77 dated 18-09-1978 and Ministry of Health and F.W. No. S. 14025/58/78-MS, dated 18-08-1978.
4. These orders have been issued in consultation with the Department of Personnel & A.R.
List of Artificial Appliances Annexed to Memo No S-14025/31-79-MS, dated the 26th September, 1980.
S.No. Artificial Appliances
1. Unilateral long leg brace without hip joint.
2. Hip Joint with pelvic band.
3. Spinal Brace.
4. Unilateral short leg brace.
5. Shoe or Boot-Protective or aiding to paralysed or weak leg.
6. Bilateral hip joint with pelvic band/weak leg.
7. Bilateral long leg Brace without hip joint.
8. Bilateral short leg Brace.
9. Lumbar-Sacral or spinal support or Back support.
10. Taylor’s Brace.
11. Milwaukee brace.
12. Mesmaid Splint.
13. Posterior slab.
14. Cervical Brace four post.
15. Rigid Cervical Collar with head extension.
16. Cervical Collar.
17. Dynamic Splint (Aluminium).
18. Cock-up Splint (plain Aluminium).
19. Cock-up Splint (Plastic) or long oponens.
20. Turn Buckle Splint.
21. Knuckle Bender Splint.
22. Anterior Knee Guard Splint.
23. Denis Brown Splint.
24. Congenital Talipus Equino Varos/Valgus Splint.
25. Short Oponens P.V.C. (Plastic).
26. Knee Cage.
27. Long Oponens with M.P.Fl. bar and finger.
28. Extension (Plastic) Dynamic.
29. Boot with C and E heel and arch support.
30. C and E heel.
31. Arch Support.
32. M.T. Pad.
33. M.T.E. Raising.
34. T. Strap.
35. Sponte heel.
36. Wedge 1/8".
37. Universal Raising 1".
38. Foot drop Splint.
39. Below Knee prosthetics (P.T.B. type prosthetics).
40. A.K. Prosthetics.
41. Aluminium adjustable above knee right splint.
42. Plastic shoulder abduction splint.
43. Plaster of Paris or Gypsona cast.
44. Modified Shoes.
45. Below Elbow Prosthesis.
46. Hooks.
47. Cosmetic Hand.
48. Splint for C.D.H.
49. Splint for Elbow.
50. Above Elbow and below elbow Prosthetics.
51. Corset.
52. Wheel Chair.
53. Protective Shoes with microcellular rubber without nails of ten with additional gadgets like adjustable springs and rockers.
54. Crutches.
55. Walking iron with Plaster Casts.
56. Calipers.
57. Braces.
58. Artificial limbs.
(ii) Copy of the Office Memorandum No. S. 14025/58/75 MC, dated the 18th August, 1978.
1. The undersigned is desired to say that the representations have been received in this Ministry that in the case of diseases like polio, an appliance is fitted to a child which has to be re-adjusted or replaced periodically as the child grows or the affected part improves. After careful consideration it has now been decided that reimbursement of cost of boot (shoe) prescribed in the case of patients should be allowed only after three years, for a maximum limit of three times, in respect of an individual, under Central Services (Medical Attendance) Rules, 1944. The re-imbursement cost of artificial appliances should be allowed only when these are certified as essential by a specialist in the concerned speciality in the hospitals and these are purchased from Rehabilitation Department of Medical College/Hospitals, Artificial Limbs Centre, Pune and such other centres and organisations recognised for the purpose.
2. In so far as persons serving in the Indian Audit and Accounts Departments are concerned, these orders have been issued after consultation with the Comptroller and Auditor General of India.
3. This issues with concurrence of the Ministry of Finance vide their U.O. No. 3520/EV(B) 78, dated the 3rd July, 1978 and will take effect from the date of issue of this memorandum.
15. List of non-reimbursable medicines of Central Services (Medical Attendance) Rules, 1944 shall be the applicable list for this rule: -
In supersession of all previous orders on the subject, the Central Govt. have issued orders to the effect that the list of medicines included in Schedule I & II appended to Central Services (Medical Attendance) Rules, 1944, as amended from time to time, shall be the list of medicines not reimbursable to a member of the All India Service or a member of his/her family under the All India Services (Medical Attendance) Rules, 1954.
[Govt. of India DP & AR No.4/11/73-AIS(III), dated 27th Sept. 1975.]
16. Restrictions in respect of reimbursement of the cost of insulin under this rule:-
I am directed to refer to this Department’s letter No.-8/10/70-AIS(-III), dated the 16th May, 1972, on the subject cited above. and to say that Audit has expressed the view that the words “a member of an All India Service is entitled to free medical attendance and treatment without restrictions” occurring therein creates an impression that it supersedes the provisions of the All India Services (Medical Attendance) Rules, 1954 and, in particular, the amendment thereto made in Notification No. 8/8/69-AIS(III), dated the 6th January, 1970, and the executive instructions contained in letter No. 6/11/58-AIS(III), dated the 2nd January, 1960, issued by the Ministry of Home Affairs.
2. The “Subject” of the letter of the 16th May, 1972, cited above, makes its scope very clear and the letter, read as a whole should not leave any doubt that it was intended to supersede only letter No. 7/3/65-AIS(III), dated the 12th March, 1965, issued by the Ministry of Home Affairs and not any other rule, order or instruction.
2.1 The provision of statutory rules cannot be superseded or modified by means of executive instructions, Accordingly, the instructions issued in the letter of the 16th May, 1972, cited above, do not supersede the provisions of the All India Service (Medical Attendance) Rule, 1954 (including the amendment thereto made through the Notification dated the 6th January, 1970.)
[Letter No. 4/1/73-AIS III dated 23.04.1973.]
17. List of expensive drugs the cost of which shall not be reimbursable to a member of Service circulated: -
I am directed to refer to rules, 2(k)(iii) and 14(i-a)-of the All India Services (Medical Attendance) Rules, 1954 as revised vide this Department’s notification of even number dated the 11th July, 1974 and to forward herewith a list of expensive drugs etc., the cost of which shall not be reimbursable to a member of an All India Services or a member of his family. The list may be circulated among the authorized medical attendants for their information and guidance.
[Letter No. 4/11/73-AIS-III dated 06.08.1974.]
18. Delegation of powers to the heads of the Department to allow refund of medical expenses in relaxation of rules: forwarding a copy of the Ministry of Finance, Govt. of India’s O.M.No.F.26(10)-EV-(B)/74 dated 16.07.1974 to the State Governments for adoption: -
I am directed to refer to the Ministry of Home Affairs’ letter No. 8/8/66-AIS(III) dated the 14th July, 1966 and to forward herewith a copy of a Ministry of Finance O.M. No. F. 26(10)-EV(B/74-dated the 16th July, 1974. It is requested that the State Government may adopt the orders contained therein respect of member of the All India Services working under them.
[Letter No. 23/5/75-AIS-III dated 19th January, 1975.]
19. Instructions of the Ministry of Finance Govt. of India regarding the reimbursement of the cost of replacement of diseased heart valves: Delegation of powers: Instruction to the State Government for adoption:-
I am directed to enclose a copy of the Ministry of Finance (Department of Expenditure) O.M. No. F-23(5)-EV(B)/77 dated the 18th Sept., 1978, regarding the reimbursement of the cost of replacement of diseased heart valves. In accordance with these orders, the reimbursement of the cost of heart valve, has been brought within the purview of the Elegised powers in terms of their earlier O.M. No. F. 21(2)-EW (B)/62 dated 17th April, 1963, a copy of which is attached to this Department’s letter No. 11023/16/76 dated 14th Dec. 1977.
2. It has been decided that the orders contained in the Ministry of Finance O.M. No. F. 23(5)-EV (b)/77 dated 18th Sept., 1978 may be adopted in respect of member of All India Services and the powers of reimbursement of the Cost of replacement of diseased heart valves may be delegated to the Heads of Department of the State Government. The initial supply of the heart valves will, however, in all cases be made only on the recommendation of the Department of Health of the State concerned.
3. Wherever the supply is approved by the Deptt. of Health of the State concerned, the administrative authority would make payment direct to the supplying agency and not direct to the member of the All India Service concerned. These orders also apply to the members of the All India Services serving in connection with the affairs of the Union and who are beneficiaries of the Central Government Health Scheme.
[DP&T letter No. 11023/14/78-AIS-III dated 06.01.1979.]
(i) O.M. No. 23(5)-EV(B)/77 of Government of India/Ministry of Finance, Department of Expenditure dated the 18th September, 1978.
1. The undersigned is directed to say that a question has been raised whether the reimbursement of the cost of the replacement of the diseased Heart Valves is covered by the powers delegated to the Ministries/Heads of Departments in terms of para 7 (b) of this Ministry’s Office Memorandum No. F. 21(2)-EV(B)/62 dated the 17th April, 1963. The matter has been considered carefully and the President has been pleased to decide that the reimbursement of the cost of replacement of diseased Heart Valves should also be brought within the purview of the delegated powers in terms of the above mentioned para 7(b). The initial supply of the Heart Valves will, however, in all cases be made only on a recommendation of the Director General of Health Services.
2. Wherever the supply is approved by D.G.H.S., the administrative authorities would be making the payment direct to the supplying agency and not direct to the Government servant concerned.
3. These orders also apply to Central Government employees who are beneficiaries of Central Government Health Scheme.
4. In so far as persons serving in the Indian Audit and Accounts Department are concerned, these orders have been issued after consultation with the Comptroller and Auditor General of India.
20. AMA may take a decision regarding admissibility/inadmissibility of the medicines specified in the Central Service Medical Attendance Rules:-
I am directed to say that a list of inadmissible Medicines specified in Schedule I and II of the Central Service (Medical Attendance) Rules are also applicable to members of All India Services under rule 2(k) (iii) of the All India Services(Medical Attendance) Rules, 1954.
2. Ministry of Health have now clarified that the list of items of allopathic medicines specified in Schedule I and II may be treated as illustrative only, indicating ineligible medicines/preparation or expensive drugs. The authorized Medical Attendant may take a decision whether a particular new medicine or preparation falls under any of the broad categories specified in Schedule I or Schedule II and shall so certify whereupon the cost such medicines may be reimbursed. A copy of the Ministry of Health and Family Welfare O.M. No S. 14025/67/I-MS dated 24.10.1986 is enclosed for ready reference.
[Letter No. 11023/6/870-AIS III dated 05.03.1988.]
I am directed to say that in accordance with the Government of India decision No. 13 below Rule 2 of the All India Services (Medical Attendance) Rules, 1954, the State Governments are competent to recognise Unani or Ayurvedic Hospitals for the purpose of treatment of All India Services Officers serving in connection with the Affairs of the State. The Government of India (Ministry of Health and Family Planning) have issued orders/instructions regarding the procedure to be followed regarding medical treatment under Indian System of Medicine and Homoeopathy in respect of Central Government servants vide their O.M. No.29/16/71-MA dated 14-09-1972 (copy enclosed).
2. It has been decided that the provisions contained in the Deptt. of Health’s O.M. referred to in para 1 above may also be adopted in respect of the members of All India Services.
3. The authorised Medical Attendant in respect of members of the AIS will have the same meaning as mentioned in para 2(i) (a) of the Ministry of Health and Family Planning O.M. No. 29-16/71-MA, dated 14-09-1972, referred to in para 1 above, and also under rule 2(a) of the AIS (Medical Attendance) Rules, 1954.
4. I am to request that the contents of this letter may be brought to the notice of the members of the Service working under the State Government.
(i) Copy of Deptt. of Health letter No. 29-16/71MA, dated 14th September, 1972.
1. Reference is invited to this Ministry’s Office Memorandum No.F. 28-26/61-HI, dated the 6th November, 1961 reproduced as Government of India decision No. 5 at page 11 of the Compilation of Central Services (Medical Attendance) Rules, 1944 and orders (1964 edition). It was clarified under para 2 that under the Medical Attendance Rules, modern system of medicine only is recognised and other systems of medicines such as Ayurvedic, Unani, Homoeopathy amount covered by these rules, and that Ayurvedic etc., hospitals are not recognised for the purpose of aforesaid orders even though some of the State Governments have recognised such hospitals for the treatment of their own employees. This decision was based on the policy of Government according to which Allopathic (Modern) scientific medicine should continue to be the basis for the development of the National Health Services in the country. The above mentioned policy decision has recently undergone modification according to which the Union and State Governments have been directed that Allopathic, Indian and Homoeopathic Systems of medicine should contribute towards the development of the National Health Services in the country.
2. The question of giving effect to the aforesaid revised policy decision in so far as medical attendance and treatment of Central Government servants and members of their families are concerned under the provisions of the Central Services (Medical Attendance) Rules have been under the consideration of the Government for some time past. It has now been decided as follows:-
(i) Authorised medical attendant for the purposes of these orders within the meaning of Rule 2 of the Central Services (Medical Attendance) Rules, 1944, will mean -
(a) In respect of a Government servant who belongs to a Central Service Class I, or whose pay is not less than Rs. 500 per mensem, Class I officers belonging to Ayurveda, Unani, Sidha and Homoeopathic Medical Services of the State/or Central Government or any other qualified medical officer, appointed by the Government, to attend its officers in the district;
(b) In respect of a Government servant not belonging to a Central Service, Class I whose pay is less than Rs. 500 per mensem, but more than Rs. 150/- per mensem, a Class II Gazetted Officer of the Department of Indian Medicine or Homoeopathy of a State or Central Government, or any other qualified Medical Officer, appointed by the Government to attend its officers in the station;
(c) In respect of any other Government servant, the physicians-in-charge of Government, Government aided Municipal and Panchayati dispensaries of Ayurveda, Sidha, Unani and Homoeopathic systems of medicines and/or any other qualified medical officer, similarly appointed.
N.B.: The term ‘qualified’ would mean in the case of Ayurveda, Unani and Sidha, persons possessing recognised medical qualifications as included in the II, III and IV Schedules of the Indian Medicines Central Council Act, 1970. As far as Homoeopathy is concerned, it would include the recognised medical qualifications as notified in the II Schedule of the Homoeopathy Central Council Bill, 1971.
(ii) Rates of fees for purposes of re-imbursement:
(a) Class I Officers belonging to Ayurveda, Unani, Sidha and Homoeopathic Medical Services of the State or Central Government of any other medical officers of equivalent status appointed by the Government....................Rs. 16
(b) Class II Officers of the Departments of Indian Medicine and Homoeopathy of a State or Central Government or any other medical officer of an equivalent status appointed by the Government........... Rs. 3.
(c) Others.....................Rs 3.
Provided that in respect of medical officers of State Governments who are not allowed to receive any payment, no fees would be reimbursable.
NOTE:- The fees prescribed in clause (a) and (b) above will be payable for consultation at the consulting room of the authorised medical attendant or at the residence of the patient.
(iii) List of admissible medicines for the purpose of reimbursement: Ayurveda, Sidha, Unani and Homeopathy.
The list of medicines in these systems approved for the purposes of reimbursement with indication of maximum prices against each medicine is given in Annexure I. In this Annexure, lists of medicines have been drawn up in three categories viz.
(a) Costly medicines and treatment like panchakarma therapy which may be prescribed only by class I officers or a doctor of equivalent rank;
(b) General medicines which may be prescribed by all authorized medical attendants, and
(c) Restricted medicines which may be deemed to be medical tonics having curative properties which may be prescribed only by a Class I and Class II Officer or by a doctor of equivalent rank.
The cost of medicines will be reimbursed on the basis of the prices indicated in the catalogues of the pharmacies concerned.
The cost of medicines indicated in Annexure I will however, be applicable in the case of medicines manufactured by private practitioners, who may be nominated as authorized medical attendants for the propose of these rules.
3. Lists of approved pharmacists Druggists/Ayurveda, Unani, Siddha and Homoeopath, Central Government servants should purchase Ayurveda/Unani/Siddha/Homeopathic medicines prescribed by their Authorised Medical Intendancies from the pharmacies or concerns or their authorized dealers indicated in the list attached (ANNEXURE-I).
4. With a view to ensuring that the incidence of expenditure on medical reimbursement in the Indian system of medicine and Homoeopathy does not tend to be unduly heavy, it has further been decided that, all claims pertaining to restricted and costly medicines and cost on therapy like panchakarma preferred by the Central Government employees in these systems should be required to be countersigned by the State Directors/Officers in-charge of Indian Systems of Medicine or Homeopathy Department of the State/Administrative or Central Government concerned. In cases where no Indian Systems of Medicine or Homoeopathy department exist, such claims may be countersigned by the Directors of Health Services of the State concerned or by any other of Indian systems of Medicine/Homeopathy Branch in the Ministry of Health and Family Planning (Department of Health) as may be authorized for the purpose. In other cases, the Controlling authorized will be empowered to dispose of claims as provided in the Central Services (Medical Attendance) Rules in accordance with these orders.
5. These orders will take effect from the 15th October, 1972. These orders are also applicable to Central Government servants and member of their families stationed in or passing through Calcutta.
6. In so far as persons serving in the Indian Audit and Accounts Departments are concerned, these orders have been issued after consultation with the Comptroller and Auditor General of India.
ANNEXURE - I
ANNEXURE - II
14. Instruction of the Ministry of Health, Govt. of India on reimbursement of expensed incurred in connection with the procurement of artificial appliances in respect of Central Government servants: Instructions to the State Governments for adoption:
The Govt. of India have decided to extend the provisions contained in the Ministry of Health and Family Welfare O.M. No. 14025/31/79-MS, dated 26-9-80 (copy reproduced below) regarding reimbursement of the cost of artificial appliances to the members of the All India Services serving in connection with the affairs of the Union. The State Govt. have been requested to adopt these orders in respect of the members of the All India Services, serving in connection with the affairs of the States.
[G. I. DP & AR No. 11023/14/80-AIS (III), dated 21st July 1981.]
(i) Copy of the letter No. S. 14025/31/79-MS, dated the 26th September, 1980, from the Government of India, Ministry of Health & Family Welfare.
1. The undersigned is directed to invite a reference to para 7(b) of the Ministry of Finance office Memorandum No. 21 (2)-EV(B)/62 dated the 17th April, 1963 (copy enclosed) which provides for reimbursement of expenses incurred in connection with the procurement of artificial appliances where necessary and justified to those covered under the CS (MS) Rules 1944, by the Ministries/Heads of Department in consultation with the Department of Health. The question of rationalisation and streamlining of the existing procedure involved in the reimbursement, of the expenses incurred on artificial appliances, its replacement, repair and adjustment has been under consideration of the Government of India. The question of drawing up a list of such artificial appliances whose cost would be reimbursible to those covered under the CS (MA) Rules 1944, has also been under consideration of the Government of India and it has now been decided as under:-
(1) The list of artificial appliances whose cost would be reimbursible to the government officials and the entitled members of their families covered under the CS (MA) Rules, 1944 is enclosed.
(2) The expenses incurred on the purchase, replacement, repair and adjustment of these appliances may be reimbursed to the government employees when these are certified essential by a specialist in the concerned speciality in the hospitals recognised under the CS (MA) Rules, 1944. The repairs and adjustments where necessitated under the advise of the medical specialist should be got done by the Rehabilitation Department of the Medical colleges and hospitals, Artificial Limb Centre, Pune and such other centres and organisations recognised for this purpose by the Central or State Government.
Where, however, under the advise of the Medical specialist the artificial appliance is to be repaired/adjusted, it has to be ensured that the cost of repairs/adjustment of appliance is less than the cost of replacement thereof.
2. It has also been decided by the Government to delegate power to all Ministries/Heads of Department to allow reimbursement of expenses incurred on the procurement/adjustment/repairs of these appliances subject to the condition that these have been done when they are certified as essential by a concerned specialists in the government/recognised hospitals under the CS (MA) Rules, 1944 and have been purchased/repaired from the Rehabilitation Department of the Medical Colleges and Hospitals, Artificial Limb Centre, Pune, and such other centres and organisations recognised for the purpose by the Central or State Government.
3. These orders will, however, not be applicable to the Artificial appliances which are covered under the specific orders of the Government of India e.g. Heart Pace Maker and replacement of its pulse generator and cost of replacement of diseased Heart valves vide Ministry of Finance O.M. No. 22(3)EV(B)/76, dated 18-06-1976, O.M. No.22 (3)-EV(B)/77 dated 18-09-1978 and Ministry of Health and F.W. No. S. 14025/58/78-MS, dated 18-08-1978.
4. These orders have been issued in consultation with the Department of Personnel & A.R.
List of Artificial Appliances Annexed to Memo No S-14025/31-79-MS, dated the 26th September, 1980.
S.No. Artificial Appliances
1. Unilateral long leg brace without hip joint.
2. Hip Joint with pelvic band.
3. Spinal Brace.
4. Unilateral short leg brace.
5. Shoe or Boot-Protective or aiding to paralysed or weak leg.
6. Bilateral hip joint with pelvic band/weak leg.
7. Bilateral long leg Brace without hip joint.
8. Bilateral short leg Brace.
9. Lumbar-Sacral or spinal support or Back support.
10. Taylor’s Brace.
11. Milwaukee brace.
12. Mesmaid Splint.
13. Posterior slab.
14. Cervical Brace four post.
15. Rigid Cervical Collar with head extension.
16. Cervical Collar.
17. Dynamic Splint (Aluminium).
18. Cock-up Splint (plain Aluminium).
19. Cock-up Splint (Plastic) or long oponens.
20. Turn Buckle Splint.
21. Knuckle Bender Splint.
22. Anterior Knee Guard Splint.
23. Denis Brown Splint.
24. Congenital Talipus Equino Varos/Valgus Splint.
25. Short Oponens P.V.C. (Plastic).
26. Knee Cage.
27. Long Oponens with M.P.Fl. bar and finger.
28. Extension (Plastic) Dynamic.
29. Boot with C and E heel and arch support.
30. C and E heel.
31. Arch Support.
32. M.T. Pad.
33. M.T.E. Raising.
34. T. Strap.
35. Sponte heel.
36. Wedge 1/8".
37. Universal Raising 1".
38. Foot drop Splint.
39. Below Knee prosthetics (P.T.B. type prosthetics).
40. A.K. Prosthetics.
41. Aluminium adjustable above knee right splint.
42. Plastic shoulder abduction splint.
43. Plaster of Paris or Gypsona cast.
44. Modified Shoes.
45. Below Elbow Prosthesis.
46. Hooks.
47. Cosmetic Hand.
48. Splint for C.D.H.
49. Splint for Elbow.
50. Above Elbow and below elbow Prosthetics.
51. Corset.
52. Wheel Chair.
53. Protective Shoes with microcellular rubber without nails of ten with additional gadgets like adjustable springs and rockers.
54. Crutches.
55. Walking iron with Plaster Casts.
56. Calipers.
57. Braces.
58. Artificial limbs.
(ii) Copy of the Office Memorandum No. S. 14025/58/75 MC, dated the 18th August, 1978.
1. The undersigned is desired to say that the representations have been received in this Ministry that in the case of diseases like polio, an appliance is fitted to a child which has to be re-adjusted or replaced periodically as the child grows or the affected part improves. After careful consideration it has now been decided that reimbursement of cost of boot (shoe) prescribed in the case of patients should be allowed only after three years, for a maximum limit of three times, in respect of an individual, under Central Services (Medical Attendance) Rules, 1944. The re-imbursement cost of artificial appliances should be allowed only when these are certified as essential by a specialist in the concerned speciality in the hospitals and these are purchased from Rehabilitation Department of Medical College/Hospitals, Artificial Limbs Centre, Pune and such other centres and organisations recognised for the purpose.
2. In so far as persons serving in the Indian Audit and Accounts Departments are concerned, these orders have been issued after consultation with the Comptroller and Auditor General of India.
3. This issues with concurrence of the Ministry of Finance vide their U.O. No. 3520/EV(B) 78, dated the 3rd July, 1978 and will take effect from the date of issue of this memorandum.
15. List of non-reimbursable medicines of Central Services (Medical Attendance) Rules, 1944 shall be the applicable list for this rule: -
In supersession of all previous orders on the subject, the Central Govt. have issued orders to the effect that the list of medicines included in Schedule I & II appended to Central Services (Medical Attendance) Rules, 1944, as amended from time to time, shall be the list of medicines not reimbursable to a member of the All India Service or a member of his/her family under the All India Services (Medical Attendance) Rules, 1954.
[Govt. of India DP & AR No.4/11/73-AIS(III), dated 27th Sept. 1975.]
16. Restrictions in respect of reimbursement of the cost of insulin under this rule:-
I am directed to refer to this Department’s letter No.-8/10/70-AIS(-III), dated the 16th May, 1972, on the subject cited above. and to say that Audit has expressed the view that the words “a member of an All India Service is entitled to free medical attendance and treatment without restrictions” occurring therein creates an impression that it supersedes the provisions of the All India Services (Medical Attendance) Rules, 1954 and, in particular, the amendment thereto made in Notification No. 8/8/69-AIS(III), dated the 6th January, 1970, and the executive instructions contained in letter No. 6/11/58-AIS(III), dated the 2nd January, 1960, issued by the Ministry of Home Affairs.
2. The “Subject” of the letter of the 16th May, 1972, cited above, makes its scope very clear and the letter, read as a whole should not leave any doubt that it was intended to supersede only letter No. 7/3/65-AIS(III), dated the 12th March, 1965, issued by the Ministry of Home Affairs and not any other rule, order or instruction.
2.1 The provision of statutory rules cannot be superseded or modified by means of executive instructions, Accordingly, the instructions issued in the letter of the 16th May, 1972, cited above, do not supersede the provisions of the All India Service (Medical Attendance) Rule, 1954 (including the amendment thereto made through the Notification dated the 6th January, 1970.)
[Letter No. 4/1/73-AIS III dated 23.04.1973.]
17. List of expensive drugs the cost of which shall not be reimbursable to a member of Service circulated: -
I am directed to refer to rules, 2(k)(iii) and 14(i-a)-of the All India Services (Medical Attendance) Rules, 1954 as revised vide this Department’s notification of even number dated the 11th July, 1974 and to forward herewith a list of expensive drugs etc., the cost of which shall not be reimbursable to a member of an All India Services or a member of his family. The list may be circulated among the authorized medical attendants for their information and guidance.
[Letter No. 4/11/73-AIS-III dated 06.08.1974.]
18. Delegation of powers to the heads of the Department to allow refund of medical expenses in relaxation of rules: forwarding a copy of the Ministry of Finance, Govt. of India’s O.M.No.F.26(10)-EV-(B)/74 dated 16.07.1974 to the State Governments for adoption: -
I am directed to refer to the Ministry of Home Affairs’ letter No. 8/8/66-AIS(III) dated the 14th July, 1966 and to forward herewith a copy of a Ministry of Finance O.M. No. F. 26(10)-EV(B/74-dated the 16th July, 1974. It is requested that the State Government may adopt the orders contained therein respect of member of the All India Services working under them.
[Letter No. 23/5/75-AIS-III dated 19th January, 1975.]
19. Instructions of the Ministry of Finance Govt. of India regarding the reimbursement of the cost of replacement of diseased heart valves: Delegation of powers: Instruction to the State Government for adoption:-
I am directed to enclose a copy of the Ministry of Finance (Department of Expenditure) O.M. No. F-23(5)-EV(B)/77 dated the 18th Sept., 1978, regarding the reimbursement of the cost of replacement of diseased heart valves. In accordance with these orders, the reimbursement of the cost of heart valve, has been brought within the purview of the Elegised powers in terms of their earlier O.M. No. F. 21(2)-EW (B)/62 dated 17th April, 1963, a copy of which is attached to this Department’s letter No. 11023/16/76 dated 14th Dec. 1977.
2. It has been decided that the orders contained in the Ministry of Finance O.M. No. F. 23(5)-EV (b)/77 dated 18th Sept., 1978 may be adopted in respect of member of All India Services and the powers of reimbursement of the Cost of replacement of diseased heart valves may be delegated to the Heads of Department of the State Government. The initial supply of the heart valves will, however, in all cases be made only on the recommendation of the Department of Health of the State concerned.
3. Wherever the supply is approved by the Deptt. of Health of the State concerned, the administrative authority would make payment direct to the supplying agency and not direct to the member of the All India Service concerned. These orders also apply to the members of the All India Services serving in connection with the affairs of the Union and who are beneficiaries of the Central Government Health Scheme.
[DP&T letter No. 11023/14/78-AIS-III dated 06.01.1979.]
(i) O.M. No. 23(5)-EV(B)/77 of Government of India/Ministry of Finance, Department of Expenditure dated the 18th September, 1978.
1. The undersigned is directed to say that a question has been raised whether the reimbursement of the cost of the replacement of the diseased Heart Valves is covered by the powers delegated to the Ministries/Heads of Departments in terms of para 7 (b) of this Ministry’s Office Memorandum No. F. 21(2)-EV(B)/62 dated the 17th April, 1963. The matter has been considered carefully and the President has been pleased to decide that the reimbursement of the cost of replacement of diseased Heart Valves should also be brought within the purview of the delegated powers in terms of the above mentioned para 7(b). The initial supply of the Heart Valves will, however, in all cases be made only on a recommendation of the Director General of Health Services.
2. Wherever the supply is approved by D.G.H.S., the administrative authorities would be making the payment direct to the supplying agency and not direct to the Government servant concerned.
3. These orders also apply to Central Government employees who are beneficiaries of Central Government Health Scheme.
4. In so far as persons serving in the Indian Audit and Accounts Department are concerned, these orders have been issued after consultation with the Comptroller and Auditor General of India.
20. AMA may take a decision regarding admissibility/inadmissibility of the medicines specified in the Central Service Medical Attendance Rules:-
I am directed to say that a list of inadmissible Medicines specified in Schedule I and II of the Central Service (Medical Attendance) Rules are also applicable to members of All India Services under rule 2(k) (iii) of the All India Services(Medical Attendance) Rules, 1954.
2. Ministry of Health have now clarified that the list of items of allopathic medicines specified in Schedule I and II may be treated as illustrative only, indicating ineligible medicines/preparation or expensive drugs. The authorized Medical Attendant may take a decision whether a particular new medicine or preparation falls under any of the broad categories specified in Schedule I or Schedule II and shall so certify whereupon the cost such medicines may be reimbursed. A copy of the Ministry of Health and Family Welfare O.M. No S. 14025/67/I-MS dated 24.10.1986 is enclosed for ready reference.
[Letter No. 11023/6/870-AIS III dated 05.03.1988.]
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