Lok Sabha Question No. 236 (UNSTARRED), answered on 2017-02-03
Subject: Physiotherapy to Paraplegic CGHS Beneficiaries
Ministry: HEALTH AND FAMILY WELFARE
Asked by: C.S. PUTTARAJU

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 236 TO BE ANSWERED ON 3 RD FEBRUARY, 2017

## PHYSIOTHERAPY TO PAR APLEGIC CGHS BENEFIC IARIES

## 236. SHRI C.S. PUTTA RAJU:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether there is any proposal to provide the facility of physiotherapist at home to Central Government Health Scheme (CGHS) beneficiaries, if not, the reasons therefor;
- (b)  the  details  of  measures  taken  to  provide  best  medical  care  facilities  to  parapleg beneficiaries;
- (c) the total number of paraplegic CGHS beneficiaries; and
- (d) whether there is any proposal to issue special cards to paraplegic CGHS beneficiaries not, the reasons therefor?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE ( FAGGAN SINGH KULASTE )

- (a)    &  (b):  There  already  exists  provision  fo r  domiciliary  rehabilitation  medical  intervention including physiotherapy for CGHS beneficiaries as per the guidelines issued vide this Ministry's Office Memorandum No. S - 11011/24/2011 - CGHS (P) dated 1.6.2011 (copy enclosed).
- (c):  CGHS  does  not  maintain  s eparately  the  record  of  the  number  of  paraplegic  CGHS beneficiaries.
- (d):  At present, there is no proposal to issue separate cards to paraplegic benefici difficult to issue special cards to the CGHS beneficiaries suffering from a particular d isease.

………………

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

No: S.11011/24/2011-CGHS (P)

Dated, the 1 st June, 2011

## O   F   F I   C   E       M   E   M   O   R   A   N   D   U   M

Guidelines for domiciliary rehabilitation medicine intervention for reimbursement to CGHS beneficiaries.

Subject:

The  undersigned  is  directed  to  as  per  extant  instructions,  domestic  rehabilitation  of CGHS beneficiaries is not permitted and the patients have to go to hospitals for physiotherapy, etc. CGHS received representations with the request that domiciliary physiotherapy rehabilitation may be permitted since in many cases it is not possible for the patients to be transported / shifted to hospitals for physiotherapy, etc.  The request was examined by a committee of experts / specialists in Government hospitals, and it has been decided to issue the following guidelines for domiciliary rehabilitation medical intervention for reimbursement to CGHS beneficiaries:

## Guidelines

Domiciliary  (home  based)  care  is  medically  justified  in  the  practice  of  rehabilitation medicine which involves the care of the patient with chronic diseases or temporary or permanent disability or functional limitation due to lack of health or disease.  It is justified as such persons find ambulation practically impossible or are significantly dependent on care giver or the cost of visiting the hospitals become higher than the cost of treatment given.  In view of this, it would be necessary to consider providing holistic domiciliary rehabilitation medicine service instead of piecemeal home based physiotherapy only, to CGHS beneficiaries as part of their routine health coverage.

## Scope of the service

The  following  allied  health  services  need  to  be  considered  for  domiciliary  case  as stated above:

- (ii) Occupational therapy; and
- (i) Physiotherapy;
- (iii) Speech therapy (for patients of stroke / head injury)

The  decision  to  provide  domiciliary care  should  be  based  on  thorough  evaluation  and  specific prescription including the exact intervention and frequency by a PMR specialist.  In a situation of non-availability  of  PMT  specialist,  the  treating  Government  specialist  having  allopathic  PostGraduate  qualifications  in  Ortho  /  Neurology  /  Neurosurgery  /  ENT  may  allow  such  benefits following the specific prescription criteria for conditions listed below:-

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## Conditions  requiring  domiciliary  rehabilitation  intervention  and  recommended  duration  if domiciliary therapy:

- (1) Orthopaedic disorders: Post joint replacement surgery in acute phase: Physiotherapy upto two weeks, post - discharge.

- (2) Neurological disorders (for upto six weeks):

- (i) Post  stroke:  Occupational  Therapy  (OT),  Physiotherapy  (PT),  and  Speech Therapy (ST);

- (ii) Traumatic brain injury: OT, PT and ST;

- (iii) Gullian-Barre syndrome: OT and PT;

- (iv) Spinal cord injury with significant disability / deformity: OT and PT; and

- (v) Motor neuron disease: OT, PT and ST.

- (3) Locomotor disabilities, with  a  disability  of  over  80%  or  those  who  are  totally dependent on care-giver  based  on  the  opinion  of  two  Government  specialists,  by  certified  care- giver. [Care-giver means Rehabilitation Council of India certified personnel + Physiotherapist and Occupational therapist (duly qualified diploma / degree holder)].

## Prescription information:

The prescription for home based rehabilitation programme should include the following descriptive specifics:

- (1) The therapy to be used:

- (a) Electrotherapy;

- (b) Active Exercise Therapy;

- (c) ADL Training;

- (d) Speech Therapy;

- (e) Gait Training; and

- (f) Passive Exercises.

- (2) The technical person required to institute the therapy;

- (3) The frequency of the therapy required by the patient; and

- (4) Duration of the therapy programme.

## Admissible rates for reimbursement:

The following rates may be reimbursed:

- (1) Physiotherapist : Maximum of Rs.300/- (Rupees Three hundred only);

- (2) Occupational Therapist
2. : Maximum  of  Rs.300/(Rupees  Three  hundred only);
- (3) Speech Therapist : Maximum of Rs.300/- (Rupees Three hundred only);
- (4) Certified Care Giver : Maximum  of  Rs.  150/(Rupees  One  hundred  and  fifty only)  or  Rs.  3,000/(Rupees  Three  thousand  only)  per  month  for  long-term requirements, whichever is less; and
- (5) No reimbursement to be allowed for the purchase / hiring of therapy equipment / devices.
2. The guidelines will take effect from the date of issue of the Office Memorandum.
3. This issues with the concurrence of IFD, vide Dy. No: 790 / SS & FA dated the 23 rd May, 2011.
4. Hindi version of the guidelines will follow.

To

1. All Ministries / Departments, Government of India
3. The  Managing  Director,  Central  Organisation  ECHS,  Army  (Hq),  Maude  Line, Delhi Cantonment, New Delhi 110 010
2. Additional Secretary, Cabinet Secretariat, Rashtrapati Bhawan, New Delhi
4. Director, CGHS, Nirman Bhawan, New Delhi
6. All Pay & Accounts Officers under CGHS
5. All Additional Directors /Joint Directors of CGHS cities outside Delhi
7. Addl DDG  (Hqrs)  /  Additional Director (Hqrs) / Additional Director (SZ) / Additional  Director  (NZ)  /  Additional  Director  (CZ)  /  Additional  Director  (EZ), CGHS, New Delhi
9. CGHS Desk-I/Desk-II/CGHS-I/CGHS-II, Dte.GHS, Nirman Bhawan. New Delhi
8. JD (Gr.)/JD(R&H), CGHS Delhi
10. Estt.I/ Estt.II/ Estt.III/ Estt.IV Sections, Ministry of Health & Family Welfare
12. Rajya Sabha / Lok Sabha Secretariat
11. Admn.I / Admn.II Sections of Dte.GHS
13. Registrar, Supreme Court of India
14. U.P.S.C.
15. Finance Division
17. PPS  to  Secretary  (H&FW)  /  Secretary  (AYUSH)  /  Secretary  (HR)  /  Secretary (AIDS Control), Ministry of Health & Family Welfare
16. Deputy Secretary (Civil Service News), Department of Administrative Reforms & Public Grievances, 5 th Floor, Sardar Patel Bhawan, New Delhi.
18. PPS to DGHS / SS & FA / SS & MD, NRHM / AS (H) / AS & DG (CGHS)
20. Nabhi Publications, P. O. Box No: 37, New Delhi 110 001
19. Swamy Publishers (P) Ltd., P. B. No. 2468, R. A. Puram, Chennai  600028
21. Bahri Brothers, 742 Lajpat Rai Market, Delhi 110 006
23. All Staff Side Members of National Council (JCM) (as per list attached)
22. Shri Umraomal Purohit, Secretary, Staff Side, 13-C, Ferozshah Road, New Delhi
24. Office of the Comptroller & Auditor General of India, 10 Bahadur Shah Zafar Marg, New Delhi
26. Sr.  Technical  Director,  NIC,  MOHFW, Nirman  Bhawan,  New  Delhi,  with  the request to upload on the website of the CGHS.
25. All Offices / Sections / Desks in the Ministry
27. Office Order folder
28. Guard File

[R Ravi] Director

[Tel: 2306 3483]