STANDARD OPERATING PROCEDURE (SOP) ON PROCESSING OF DOMICILIARY MEDICAL EQUIPMENT (DME) CASES UNDER EX-SERVICEMEN CONTRIBUTORY HEALTH SCHEME (ECHS)
1. Purpose:
This Standard Operating Procedure (SOP) lays down the procedure for processing, scrutiny, approval, procurement, issue and reimbursement of Domiciliary Medical Equipment (DME) under ECHS to ensure uniform implementation of Government policy, transparency, accountability and timely provision of Domiciliary Medical Equipment to eligible ECHS beneficiaries.
2. Scope:
This SOP will be applicable to all ECHS beneficiaries, ECHS Polyclinics, Regional Centres (RCS), Central Organisation ECHS, Service Hospitals, Government Hospitals, Empanelled Hospitals and all authorities involved in processing DME cases under ECHS. It covers procurement through SEMO, procurement by ECHS beneficiaries after obtaining prior approval from the competent authority, reimbursement, ex-post facto approval in applicable cases, and processing of specialized Domiciliary Medical Equipment including CSII Pump Therapy, Cochlear Implant and Artificial Appliances under the relevant Government orders.
3. References:
3.1. MoD/DOESW File No. 18(114)/2017/WE/D(Res-l) dated 18 Sep 2019 on subject DOMICILIARY MEDICAL EQUIPMENT FOR ECHS BENEFICIARY.
3.2. CO ECHS policy letter No. B/49761/AG/ECHS/Medicine Policy/2023 dated 30 Nov 2023, 12 Dec 2023 and 12 Mar 2024 on subject EXECUTIVE INSTRUCTIONS: DOMICILIARY MEDICAL EQUIPMENT FOR ECHS BENEFICIARIES.
3.3. CO ECHS policy letter No. B/49761/AG/ECHS/Medicine Policy/2025 dated 05 May 2025 on subject DOMICILIARY MEDICAL EQUIPMENT FOR ECHS BENEFICIARY: PROVISION OF EX-POST FACTO APPROVAL AND REIMBURSEMENT OF THE COST OF LIFE SAVING DOMICILIARY MEDICAL EQUIPMENT OXYGEN CONCENTRATOR/ CPAP/BIPAP/ BILEVEL VENTILATORY SYSTEM OR ANY OTHER LISTED DOMICILIARY MEDICAL EQUIPMENT REQUIRED URGENTLY.
3.4. MoD/DoESW letter ID No. 18(114)/2017-D(WE/Res-I), dated 7 Mar 2025 on subject DOMICILIARY MEDICAL EQUIPMENT FOR ECHS BENEFICIARY: PROPOSAL FOR PROVISION OF EX- POST FACTO APPROVAL AND REIMBURSEMENT OF THE COST OF SAME CHARGES FOR LIFE SAVING DOMICILIARY MEDICAL EQUIPMENT- OXYGEN CONCENTRATOR/CPCP/BIPAP – reg.
3.5. MoD/DoESW letter No. 22D(22)/2024/WE/D (Res-1) dated 2 Apr 2025 on subject GUIDELINES REGARDING REIMBURSEMENT OF CONTINUOUS SUBCUTANEOUS INSULIN INFUSION (CSII) PUMP THERAPY.
3.6. MoHFW Office Memorandum F. No: 6-469/2003-CGHS/R&H dated 12 Jun 2009 on subject REIMBURSEMENT OF THE COST OF COCHLEAR IMPLANT TO BENEFICIARIES UNDER CGHS /CENTRAL SERVICES (MEDICAL ATTENDANCE) RULES, 1944.
3.7. MoHFW Office Memorandum No. S-11011/25/2014/CGHS-(P) dated 08 Jul 2014 on subject REVISION OF LISTS AND RATES OF ARTIFICIAL APPLIANCES FOR CGHS/CS(MA) BENEFICIARIES AND GENERAL GUIDELINES FOR ELIGIBILITY CRITERIA THEREFOR.
3.8. General Financial Rules (GFR) 2017. 3.9. Any subsequent Government orders issued by MoD/DOESW, MOHFW, O/o DGAFMS, CO ECHS.
4. Eligibility:
Eligible ECHS beneficiaries may be considered for issue of Domiciliary Medical Equipment provided the equipment is medically essential, prescribed/recommended by the concerned Specialist/Super Specialist of a Service Hospital/Government Hospital, required for domiciliary management, not intended for hospital use and covered under the extant Government policy.
5. Categories of Domiciliary Medical Equipments,
For the purpose of processing under this SOP, Domiciliary Medical Equipment will be categorized as under:
Category I: Items available in Government approved list with prescribed ceiling rate: Eg: CPAP, BIPAP, BILEVEL Ventilatory System, Oxygen Concentrator, Wheel Chair, Hearing aids and other listed DME with CGHS/ECHS ceiling rate.
Category II: Specialized Domiciliary Medical Equipments, examples: Continuous Subcutaneous Insulin Infusion (CSII) pump therapy, Cochlear implant and other High-end appliances.
Category III: Un-listed Domiciliary Medical Equipments, equipment not included in approved Government list and for which no CGHS/ECHS ceiling rates exist, examples: Multipara monitor, Motorized ICU bed, Air mattress, Suction apparatus, DVT pump with sleeves etc.
6. Modes of Procurement of Domiciliary Medical Equipment
6.1. Along with the supporting documents (Prescription, Clinical summary, Investigation reports and Recommendation of concerned Specialist/Super Specialist of Service/Govt hospital) demand of DME will be forwarded by Officer-in-charge ECHS Polyclinic to respective Senior Executive Medical Officer (SEMO). Once the DME is procured by SEMO, it will be issued to ECHS beneficiary on issue voucher. A copy of issue voucher will be kept in ECHS Polyclinic for future reference and audit purpose.
6.2. Procurement by individual ECHS beneficiary with prior approval/sanction of competent authority and claim for re-imbursement.
7. Prior approval by Competent Authority
7.1. Checklist of mandatory documents for prior approval of Category- 1 domiciliary medical equipments (Competent Authority- Director Regional Centre ECHS)
7.1.1. Prescription, Clinical summary, Investigation reports of ECHS beneficiary
7.1.2. Recommendation of concerned Specialist/Super Specialist of Service/Govt hospital
7.1.3. Application of ECHS beneficiary for permission for individual procurement and claim reimbursement as per CGHS/ECHS ceiling rate
7.1.4. ECHS Card
7.1.5. Statement of Case with justification from ECHS Polyclinic
7.1.6. Undertaking certificate for acceptance of reimbursement at CGHS/ECHS ceiling rate
7.2. Mandatory documents checklist for prior approval of Category II and Category-III domiciliary medical equipments (Competent Authority- High Power Committee/DOESW)
7.2.1. Prescription, Clinical summary, Investigation reports of ECHS beneficiary
7.2.2. Recommendation of concerned Specialist/Super Specialist of Service/Govt hospital
7.2.3. Application of ECHS beneficiary for permission for individual procurement and claim reimbursement as per CGHS/ECHS ceiling rate
7.2.4. ECHS Card
7.2.5. Undertaking certificate for acceptance of reimbursement at CGHS/ECHS ceiling rate
7.2.6. Statement of Case (SOC) with justification from ECHS Polyclinic
7.2.7. Recommendation of Director Regional Centre ECHS
7.2.8. Three quotations from authorized distributors in case the cost of DME is above Rs. 50,000/-. For DME upto a monetary value of Rs. 50,000/- purchase may be made without inviting quotations provided the item is not obtainable in a GeM portal. (Rule 154 of GFR-2017).
7.2.9. Any other case specific relevant document.
8. Responsibilities of Stakeholders
8.1. ECHS Beneficiary: Submission of application and documents as per checklist.
8.2. Treating Specialist/Super Specialist of Service/Govt Hospital: Clinical recommendation.
8.3. ECHS Polyclinic: Verification of documents, forwarding Statement of Case and maint of records.
8.4. SEMO: Procurement, issue and maintenance of records.
8.5. Regional Centre ECHS: Scrutiny of documents as per checklist and recommendations.
8.6. Central Organization ECHS: Technical scrutiny, policy examination, processing of cases for submission to High Power Committee.
9. Workflow for Processing of Domiciliary Medical Equipment Cases (attached as Appx ‘B’).
10. Ex-post Facto Approval Procedure
10.1. Applicability: Ex-post facto approval will be applicable only in cases covered under the extant Government policy, where an ECHS beneficiary has procured a life-saving Domiciliary Medical Equipment in an emergency due to immediate medical necessity and prior approval of the competent authority could not be obtained. Such cases will be processed strictly in accordance with the applicable Government orders (Authority: GOI MOD letter No MoD/DOESW ID No.18(114)/2017-D(WE/Res-l) dated 07 Mar 2025).
10.2. Life-saving Domiciliary Medical Equipments: Life-saving Domiciliary Medical Equipments include Oxygen Concentrator, CPAP, BIPAP, Bilevel Ventilatory System and any other listed Domiciliary Medical Equipment required urgently for an ECHS beneficiary. Reimbursement of cost of equipments upto CGHS/ECHS ceiling limit, admissible under the extant Government policy.
10.3. Documents required: The following documents will accompany the proposal:
10.3.1. Application from the ECHS beneficiary requesting ex-post facto approval and reimbursement
10.3.2. Emergency certificate/ justification by treating doctor indicating the immediate requirement of the Domiciliary Medical Equipment for home-based care
10.3.3. Clinical summary and relevant investigation reports
10.3.4. Recommendation of the concerned Specialist/Super Specialist of a Service Hospital/Government Hospital
10.3.5. Original purchase invoice, payment receipt and warranty documents
10.3.6. Copy of ECHS Card
10.3.7. Statement of Case (SOC) with recommendations of the Officer-in-Charge, ECHS Polyclinic
10.3.8. Any other document considered necessary by the Competent Authority (Dir Regional Centre ECHS)
10.4. Examination and Approval process: The Officer-in-Charge, ECHS Polyclinic will verify the documents and forward the proposal to the concerned Regional Centre ECHS. The Regional Centre ECHS will examine the proposal in accordance with the extant ECHS policy. The approval will be provided by competent authority i.e. Director Regional Centre. Cases where no ceiling rate has been prescribed or is an unlisted equipment, the same will be referred to the High Power Committee/DoESW through Central Org ECHS.
10.5. Workflow for Processing of Ex-Post Facto approval of Domiciliary Medical Equipment procured by ECHS beneficiary under emergency condition: (attached as Appx ‘B’).
11. Reimbursement Process:
Following documents should be submitted by ECHS Beneficiary for claiming reimbursement of Domiciliary Medical Equipment:
11.1. Prior sanction letter of Director RC ECHS or High-Powered Committee
11.2. Original Bill of Domiciliary Medical Equipment
11.3. Contingent Bill
11.4. Cancelled Cheque/Bank details of beneficiary
11.5. Copy of ECHS Card of beneficiary
11.6. Certificate from PC that the same type of equipment for the purpose was not issued in last five years
12. Consumables for Domiciliary Medical Equipment:
The consumables for the equipments will be procured by SEMO/Comdt/CO Hosp and issued under arrangements of OIC ECHS Polyclinic. In case item is NA medical stores of Polyclinic, consumables will be issued through Authorised Local Chemist (ALC). If the same is not available in ALC/dispensary of ECHS Polyclinic then NA on prescription will be given to the beneficiary based on which ECHS beneficiary can purchase from local market and claim reimbursement as per ECHS policy extant.
13. Repair & Maintenance/Annual Maintenance:
Domiciliary Medical Equipment is issued for a period of five years. The repair and maintenance of Domiciliary Medical Equipment during this period will be the responsibility of the ECHS beneficiary. Cost of repair & maintenance will be borne by the beneficiary themselves and will not be reimbursable. In case of warranty is valid on the DME, the beneficiary may approach the OEM/SEMO based on the mode of procurement.
14. Replacement of Domiciliary Medical Equipment:
Request for replacement of Domiciliary Medical Equipment after completion of five years can be processed based on condition of the equipment. Following procedure will be adopted for Replacement of Domiciliary Medical Equipment:
14.1. Domiciliary Medical Equipment procured by SEMO: If Domiciliary Medical Equipment is procured and issued by SEMO and equipment is nonfunctional after completion of five years of purchase, Unserviceability Certificate will be obtained by OIC ECHS Polyclinic from Authorised Service Engineer of OEM with assistance of SEMO if required. Based on Unserviceability Certificate, Replacement of Domiciliary Medical Equipment can be processed in similar manner as for the first issue of machine/equipment.
14.2. Domiciliary Medical Equipment procured by ECHS Beneficiary: If the Domiciliary Medical Equipment is non-functional after completion of five years of purchase, then ECHS beneficiary should obtain Unserviceability Certificate from Authorized Service Engineer of Original Equipment Manufacturer (OEM). Based on Unserviceability Certificate, Replacement of Domiciliary Medical Equipment can be processed in similar manner as for the first issue of the equipment. (Authority Central org ECHS letter No B/49761/AG/ECHS/Medicine Policy/2023 dated 30 Nov 2023).
14.3. In the event that the Domiciliary Medical Equipment becomes unserviceable before completion of five years from the date of issue/purchase, the warranty conditions will apply, provided the equipment is covered under warranty. If the warranty period is over, similar procedure as given out in Para 14.1 & 14.2 above will be followed.
15. Expenditure:
15.1. The expenditure on procurement of Domiciliary Medical Equipment by the SEMO will be debited to Major Head 2076 Minor Head 107 (C) Code Head 363/01.
15.2. The expenditure on procurement of Domiciliary Medical Equipment by the individual beneficiary will be debited to Major Head 2076 Minor Had 107 Code Head 365/00 for which the payment will be made by respective Regional Centres as per extant procedure for payment of individual reimbursement.
16. CFA
16.1. Domiciliary Medical Equipment procured by SEMO: CFAs will be as per schedule 2.4, DFPDS-2016 as amended from time to time.
16.2. CFA for individual reimbursement of cost of Domiciliary Medical Equipment will be as per Para 1 of Govt of India, Ministry of Defence (DOESW) ID No 25(01)/2018/WE/D(Res-I) dt 09 Jul 2019 as amended from time to time.
17. This has approval of MD ECHS.
Appx enclosed:
- Appx ‘A’: Checklist of Documents
- Appx ‘B’: Processing Flowchart
- Appx ‘C’: List of Reference Policy Letters
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