1. Because every child is unique RASHTRIYE BAL SWASTHYA KARYAKRAM Accredited Hospitals Meeting New treatment order on 26 AUGUST, 2016 National Health Mission, Madhya Pradesh

2. 1. 0bjectives of RBSK and its implementation in MP. 2. Role of Accredited Hospital under RBSK. 3. Discussion on treatment order issued by Govt of MP. 4. Costing Packages. 5. Reporting Format.

4. 1- “ There is only one perfect child, and every mother has one !! ” ^^ nqfu;k esa,d gh loZJs"B f’k’kq gS] vkSj og gj ekW ds ikl gS !! ” **vkSj gj ekW ds bl loZJs"B,oa vf}rh; f’k’kq dks 'kkjhfjd,oa ekufld :i ls LoLF; j[kus dh uSfrd ftEesnkjh LokLF; foHkkx dh gSA**

5.  Rashtriya Bal Swasthya Karyakram (RBSK) is a new initiative aimed at screening of children from 0 to 18 years for 4 Ds - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities.  Children diagnosed & treated with illnesses shall receive follow up including surgeries at tertiary level, free of cost under NHM.

6. Defects Deficiency Delays Diseases

7. Defect at Birth Out of every 100 babies born 6 to 7 have Defect at Birth. In India estimate about 1.7 million babies born with Birth Defects annually. Congenital Malformation were the 2nd most commonest cause 9.9% of Mortality among still birth.

8. Deficiency  Various nutritional deficiencies affecting the preschool children range from 4 percent to 70 percent.Disease  Prevalence of Dental carries (50%-60% ), Rh.H.D. is reported (1.5/1000 ) in age group of 5-9 years and reactive Airway Disease ( 4.75%) are very common diseases in children

9. Developmental Delay and disabilities  Developmental delays are common in early childhood affecting 10% of the children. SNCU REPORTS  Special New born care units Technical reports have reported that approximate 20% Babies discharge from health facilities are found to Suffer from developmental delay or disabilities at later age.

11. Screening and Management of Birth Defects in Children from birth to 18 years AgeScreeningEvaluationManagement  Birth : at all delivery points Doctors & NursesAt Early Intervention Centre Medical & Surgical secondary and tertiary care hospitals  Special New Born Care Units (High risk) Doctors, Nurses & Domain specific experts At Early Intervention Centre situated at District Hospital Medical & Surgical secondary and tertiary care hospitals  Birth to 6 weeks during home visit Community Level Health Worker (ASHA) At Early Intervention Centre situated at District Hospital Medical & Surgical secondary and tertiary care hospitals  6 weeks to 6 years at community level At Anganawadi Centres by dedicated Mobile Health Team (MHT) twice a year At Early Intervention Centre situated at District Hospital Medical & Surgical secondary and tertiary care hospitals  6 to 18 years At Schools by dedicated Mobile Health Team (MHT) At Early Intervention Centre situated at District Hospital Medical & Surgical secondary and tertiary care hospitals

12. District Early Intervention Clinic 'kh?kz&igpku]'kh?kz gLr{ksi Identification Intervention Critical Period (0-8 Years approx.) Pediatrician Psychiatrist Psychologist Ophthalmologist Audiometric Physiotherapist Counselor Well being

13.  “It’s not a drug, it’s not a vaccine, and it’s not a device. It is a group of therapists working together, solving problems and enhancing capabilities”

14. Role of Accredited Hospital under RBSK

15.  Accredited Hospital should follow the treatment protocol for identified child.  Hospital should perform surgery under costing package.  To ensure proper follow up of treated child as per guideline.  Proper coordination between state /division and district level.  Hospital get permission from state for accreditation.  Hospital should be NABH entrance level certification.

16. Agenda- 3 ORDERS RELEASED BY State Government under RBSK MP

18. ;kstuk ds varxZr ik= fgrxzkgh %&  5 o"kZ rd vk;q ds Jo.k ckf/kr fpgkafdr leLr cPps ;kstukarxZr ik= fgrxzkgh gksaxsA  fo'ks"k ifjfLFkfr;ksa esa fo'ks"kK fpfdRld }kjk fn, er mijkar 7 o"kZ rd ds Jo.k ckf/kr cPps ;kstukarxZr ik= fgrxzkgh gksaxsA  cPps ds vfHkHkkod dks izns'k dk ewy fuoklh gksuk vfuok;Z gSA  Jo.k cf/kr fpagkfdr cPpksa dks loZizFke Hearing Aid vko';d :i ls N% ekg rd iznku djsa rRi'pkr iqu% ijh{k.k djkosa dh Hearing Aid ls Jo.k esa lq/kkj gqvk gS vFkok ugha] lq/kkj u gksus ij gh dkWfDy;j bEIykUV djk;k tkosA

19. eq[;ea=h cky Jo.k ;kstuk ds varxZr mipkj gsrq ik= fpfdRlk laLFkk u dkWfDy;j bEIykUV ds fy, fuEu ekU;rk izkIr fpfdRlky; esa ;kstukarxZr mipkj iznku fd;k tk ldrk gS %&  vjfcanks esfMdy dkWyst,oa fpfdRlky;] bankSj  fpjk;q esfMdy dkWyst Hkksiky ,y-,u-esfMdy dkWyst,oa ts-ds-gkfLiVy Hkksiky  fnO;,Mokla bZ-,u-Vh-Dyhfud] Hkksiky ,El lkdsr uxj Hkksiky  ih-Mh-fgUnqtk us'kuy gkfLiVy] eqEcbZ  yhykorh gkWfLiVy] eqEcbZ  tkenkj gkWfLiVy izkbZosV fyfeVsM] tcyiqj

20.  jklsUnz eseksfj;y ukgj bZ-,u-Vh- gkWfLiVy lruk  fiiqYl gkWfLiVy Hkksiky  gtsyk fpfdRlky] dksVjk Hkksiky  dsfj;j baLVhV~;wV vkWQ esfMdy lkbalsl] Hkksiky  ch-vkbZ-,e-vkj- gkWfLiVy Xokfy;j jslhMsalh] Xokfy;j  vkdk’k gkWfLiVy,oa MkbXuksfll gsYFk lsaVj bankSj  ’;ke ’kkg esfMdy dkWyst jhok  vf[ky Hkkjrh; vk;qfoZKku laLFkku ¼,El½] ubZ fnYyh dkWfDy;j bEIykUV ds fy;s ADIP ls ekU;rk izkIr gksuk vko’;d gSA Lohd`fr jkT; ’kklu }kjk iznk; dh tkosxhA

21. ’krsZa %&  ekU;rk izkIr fpfdRlky; dkWfDy;j bEIykaV ekWMy dkWfLVax iSdst vuqlkj jkf’k :- 5-20 yk[k :i;s esa laikfnr djsaxsA  bl jkf’k esa cPpksa ds fpgkadu dk O;; Hkh lfEEkfyr gSA  cPpksa ds ftyk Lrj ij fpgkadu ds fy;s ;fn dksbZ fpfdRlky; dSEi vk;ksftr djrk gS rks cPpksa dh leLr tkap fu%’kqYd djsxk] tkap gsrq i`Fkd ls dksbZ jkf’k ns; ugha gksxhA  lacaf/kr fpfdRlky; dks cPpsa ds mipkj ds le; ejht ds lkFk jgus okys,d O;fDr dks fu%’kqYd vkokl,oa Hkkstu dh O;oLFkk miyC/k djkuh gksxhA  ekU;rk izkIr fpfdRlky; ejht ds fMLpktZ mijkar,d ekg rd leLr vkS"k/kh fu%’kqYd miyC/k djk;sxkA

22.  fpfdRlky; cPps ds HkrhZ gksus ij mipkj ds le; gksus okyh leLr tkaps fu%’kqYd miyC/k djk;sxkA  fpfdRlky; dkWfDy;j bEIykaV USFDA ekU;rk izkIr fuekZrk dk Ø; dk yxk;sxsa rFkk bEIykaV dk uEcj fMLpktZ fVdV,oa ns;dksa ij vfuok;Zr% vafdr djuk gksxkA  fpfdRlky; dks mi;ksfxrk izek.k&i= jkf’k miyC/k gksus ds,d ekg ds vanj lacaf/kr eq[; fpfdRlk,oa LokLF; vf/kdkjh dks vfuok;Zr% Hkstk tkuk gksxkA  mi;ksfxrk izek.k&i= esa ;g Hkh vafdr djuk gksxk fd fpfdRlky; }kjk ejht ls dksbZ Hkh vfrfjDr jkf’k tkap ;k vkS"k/kh gsrq ugha yh xbZA ¼mi;ksfxrk izek.k i= layXu½

23.  fpgkafdr cPpksa dks dkWfDy;j bEIykaV dh Lohd`fr laHkkxh; la;qDr lapkyd }kjk tkjh dh tkosxhA  fpfdRlky; cPpksa dks fpgkafdr dj ftys ds eq[; fpfdRlk,ao LokLF; vf/kdkjh ds ikl Hkstsxsa] eq[; fpfdRlk,oa LokLF; vf/kdkjh izdj.k rS;kj dj laHkkxh; la;qDr lapkyd dks izsf"kr djsaxs] la;qDr lapkyd ekg esa nks ckj fefVax vk;ksftr dj dkWfDy;j bEiykaV dh Lohd`fr iznku djsaxsA  ftl fpfdRlky; }kjk izkDdyu fn;k x;k gS ;k cPps dks fpgkafdr fd;k x;k gS mlh fpfdRlky; dks bEIykaV gsrq Lohd`fr tkjh dh tkosxh] dsoy ifjtuksa ds euk djus ij blesa ifjorZu fd;k tk ldrk gSA  laHkkxh; la;qDr lapkyd ls Lohd`fr izkIr gksus ij eq[; fpfdRlk,oa LokLF; vf/kdkjh,d lIrkg esa cPps dks bEIykaV gsrq HkstsaxsA

24. QkWyksvi %&  bEIykaV ds 3 ls 4 lIrkg esa cPps dk Qkyksvi fd;k tkosxk ;g Qkyksvi,u-vkj-Vh-¼U;wjy fjLikal VsfyfeVªh½ gsrq gksxk blesa bEIykaV dks fØ;k’khy fd;k tkrk gSA blds ckn cPpsa dk QkWyksvi%&  izFke ekg & izfr lIrkg  f}rh; ekg ls 6 ekg rd & ekg esa,d ckj  6 ekg ds ckn & 2 ekg esa,d ckj U;wure 12 Qkyksvi  fpfdRlky; cPpksa ds vfHkHkkodksa dks ?kj ij Fksjsih gsrw xkbM+ykbu ¼ekxZnf’kZdk½ Hkh miyC/k djk;sxs rkfd cPpksa ds vfHkHkkod ?kj ij cPpksa dks fu;fer Fksjsih iznku dj ldsaA

26.  ;kstuk ds varxZr ik= fgrxzkgh %& 0 ls 18 o"kZ ds fpgkafdr leLr cPps ;kstuk ds varxZr ik= fgrxzkgh gksaxsA cPps ds vfHkHkkod dks izns'k dk ewy fuoklh gksuk vfuok;Z gSA  ;kstuk ds varxZr mipkj gsrq ik= laLFkku %&  Izkns’k,oa ns’k ds leLr ’kkldh; fpfdRlk egkfo?kky;A  jkT; Lrj ls ekU;rk izkIr fpfdRlky;  izns’k ds ckgj ds,u-,-ch-,p- ekU;rk izkIr fpfdRlky; ftudh ekU;rk jk"Vªh; LokLF; fe’ku }kjk tkjh dh xbZ gSA  izns’k ds ckgj ds,u-,-ch-,p- ekU;rk izkIr fpfdRlky; ftudh ekU;rk jkT; Lrj ls tkjh dh xbZ gSA

27. 'krZ %&  ekU;rk izkIr fpfdRlky; vkj-ch-,l-ds- izksfltj dksM esa fu/kkZfjr ekWMy dkWfLVax iSdst vuqlkj ejhtksa dk mipkj djsaxsA  ekU;rk izkIr fpfdRlky; ftyk Lrj ij fu%’kqYd dSEi vk;ksftr dj cPpksa dh fu%’kqYd tkap djsxkA tkap gsrq i`Fkd ls fdlh Hkh fpfdRlky; dks dksbZ jkf'k ns; ugha gksxhA  ekU;rk izkIr fpfdRlky; ;fn ftyk Lrj ij dSEi vk;ksftr dj cPpksa dk fpgkadu djrk gS rks dSEi esa vkus okys cPpksa,oa musd lkFk vkus okys,d ifjtu dks fu%’kqYd Hkkstu O;oLFkk miyC/k djkosxkA  ;fn cPps dks,d ls vf/kd ân; jksx gS rks,sls cPpksa ds iw.kZ mipkj dk izkDdyu lacaf/kr fpfdRlky; dks nsuk gksxkA izkadyu esa,d ls vf/kd lHkh ân; jksx dk mYys[k djrs gq;s izkdayu izLrqr djuk gksxk rFkk leLr ltZjh lacaf/kr fpfdRlky; dks djuh gksxhA

28. 'krZ %&  fpgkafdr ejht ds HkrhZ gksus ij ejht ds lkFk jgus okys,d ejht dks vkokl,oa Hkkstu dh O;oLFkk lacaf/kr fpfdRlky; dks fu%’kqYd djuh gksxhA  lacaf/kr fpfdRlky; dks ejht ds LVs’ku ls fpfdRlky;,oa fMLpktZ mijkar fpfdRlky; ls LVs’ku rd vkus&tkus dh O;oLFkk miyC/k djkuh gksxhA  HkrhZ ds le; leLr tkap fu%’kqYd gksxh lkFk gh ;fn ejht dks jDr dh vko’;drk gS rks og Hkh fu%’kqYd fpfdRlky; }kjk miyC/k djkuk gksxkA

29.  fMLpktZ mijkar 3 ekg rd vkS"k/kh lacaf/kr ejht dks fu%’kqYd miyC/k djkuh gksxh rFkk leLr Qkyksvi fu%’kqYd djkus gksaxsA  fpfdRlky; fu/kkZfjr dkWfLVax iSdst ds vfrfjDRk vU; dksbZ jkf’k lacaf/kr ejht ls ugha ysxkA  lacaf/kr fpfdRlky; dks mi;ksfxrk izek.k&i= jkf’k miyC/k gksus ds,d ekg esa tek djuk vfuok;Z gksxkA mi;ksfxrk izek.k i= ds lkFk fpfdRlky; dks ;g Hkh vafdr djuk gksxk fd muds }kjk ejht ls dksbZ vfrfjDr jkf’k ugha yh xbZA  mi;ksfxrk izek.k&i= ds lkFk vko’;d nLrkost Hkh lacaf/kr fpfdRlky; dks izLrqr djus gksaxs tks dkWfLVax iSdst ds lkFk mYysf[kr gSA  ejht dh Lohd`fr ftyk Lrj ls tkjh dh tkosxhA blds fy;s eq[; fpfdRlk,oa LokLF; vf/kdkjh dh v/;{krk esa,d lfefr xfBr dh tk pqdh gSA tks ejht ds izdj.k Lohd`r dj lacaf/kr ekU;rk izkIr fpfdRlky; dks HkstsaxsA

30. e/;izns'k 'kklu yksd LokLF;,oa ifjokj dY;k.k foHkkx ea=ky; vkns'k Hkksiky] fnukad 27 ebZ] 2016 Øa-,Q 9&02@2016@l=g@esfM&3 % jk"Vªh; LokLF; fe'ku }kjk lapkfyr jk"Vªh; cky LokLF; dk;ZØe ds varxZr eksckbZy gsYFk Vhe }kjk 0 ls 18 o"kZ ds leLr cPpksa dks LØhfuax dj 4-D ds /kukRed ik, tkus ij mUgsa fu%'kqYd mipkj iznku fd;k tkuk gSA tUetkr fod`fr,oa vU; fpgkafdr chekjh gsrq fpagkafdr ekU;rk izkIr fpfdRlky;ksa easa tgka budk mipkj laHko gSA Hkkjr 'kklu }kjk fpgkafdr chekjh gsrq izkslhtj dksM vuqlkj ekWMy dkWfLVax iSdst fu/kkZfjr fd;k x;k gSA ân; jksx,oa Jo.k ckf/kr cPPkksa dk mipkj eq[;ea=h cky ân; ;kstuk,oa eq[;ea=h cky Jo.k ;kstuk ds varxZr gh fn, x, funsZ'kkuqlkj djk;k tkuk gSA 'ks"k chekjh ds fpgkafdr cPPkksa ds mipkj gsrq fuEukuqlkj funsZ'k tkjh fd, tkrs gSa %&

31. ik=rk %& 0 ls 18 o"kZ ds fpgkafdr leLr cPps bl ;kstuk ds varxZr ik= fgrxzkgh gksaxsA ftudh chekjh gsrq izkslhtj dksM vuqlkj ekWMy dkWfLVax iSdst esa jkf'k Lohd`r gSA blds vfrfjDr dksbZ jkf'k ns; ugha gksxhA

32. ;kstuk ds varxZr mipkj gsrq ik= laLFkku %&  izns'k,oa ns'k ds leLr 'kkldh; fpfdRlk egkfo|ky;A  jkT; Lrj ls izns'k ds ekU;rk izkIr fpfdRlky;A  izns'k ds ckgj ds,u-,-ch-,p- ekU;rk izkIr fpfdRlky; ftudh ekU;rk jk"Vªh; LokLF; fe'ku }kjk tkjh dh xbZ gSA  izns'k ds ckgj,u-,-ch-,p- ekU;rk izkIr fpfdRlky; ftudh ekU;rk jkT; Lrj ls tkjh dh xbZ gSA  fodkl[k.M Lrj ij nar fpfdRlk mipkj gsrq eq[; fpfdRlk,oa LokLF; vf/kdkjh }kjk izsf"kr vuq'kalk ij,u-,p-,e- }kjk ftu fpfdRlky;ks dh Lohd`fr tkjh dh xbZ gksA  izns'k ds leLr ftyk fpfdRlky;A

33. 'krZ %&  eq[;ea=h cky ân; mipkj ;kstuk dh leLr ’krZ ekU; gksxhA  dkWfLVax iSdst ds varxZr mipkj gsrw Lohd`fr dh ekU;rk ’kklu Lrj ls izkIr dh tkuk gksxhA futh fpfdRlky; ekU;rk  jkT; ’kklu }kjk fpfdRlky; dks ftl mipkj gsrw ekU;rk iznku dh xbZ gSA og ml mipkj gsrw vf/kd`r gksxsA mlds vfrfjDr vU; dksbZ mipkj gsrw fpfdRlky; vf/kd`r ugh gksxsA

35. eq[;ea=h cky Jo.k ;kstuk jk"Vªh; LokLF; fe'ku] e/;izns'k Model Costing of Surgical Packages Under RBSK A surgical package includes the cost of all pre-operative investigations, cost of surgery, cost of post-operative care including hospital stay and follow up care. (Any additional stay in case of undue and unforeseen complications may be included separately provided proper justification has been made) S. NoHealth Condition DiseaseSurgical Procedure ICD-9 Procedure Code RBSK Procedu re Code RBSK Model costing (Rupees) Pre-operati ve Investigati ons Post-operative Evidence 1 Congenital Deafness Behind Ear Analogue Hearing Aid 20.952110,000 Pure Tone Audiometry (PTA)/ Impedance Audiometry (IA) (with Stapedial Reflex) Cl. photo with hearing aid Surgery for Cochlear Implant 20.9225,20,000 Hearing Aid Trial/ IA (with Stapedial Reflex)/ Brainstem Auditory Evoked Response (BERA)/ MRI Brain with Contrast/ CT scan Brain-plain and contrast PTA, IA (with Stapedial Reflex), Implant registration form, Warranty, invoice, Telemetry report, Scar photo

36. eq[;ea=h cky ân; mipkj ;kstuk jk"Vªh; LokLF; fe'ku] e/;izns'k Model Costing of Surgical Packages Under RBSK This section outlines the Model costs of surgical packages under RBSK to be used as a reference by the states. A surgical package includes the cost of all pre-operative investigations, cost of surgery, cost of post-operative care including hospital stay and follow up care. (Any additional stay in case of undue and unforeseen complications may be included separately provided proper justification has been made) S. No Health Condition DiseaseSurgical ProcedureICD-9 Procedure Code RBSK Procedure Code RBSK Model costing (Rupees) Pre-operati ve Investigati ons Post-operative Evidence 1 Congenital Heart Disease (CHD)* Atrial Septal Defect (ASD) ASD Device Closure35.512395,000 Echoardiogram (Echo) / ECG (Electro Cardiogram)/ Chest X-ray PA view (1 film)/ Cardiac CATH/ TEE (Transesophageal Echocardiogram) Echo, ECG, Procedure CD ASD Surgical Closure (Intracardiac repair) 35.712485,000 Echo/ ECG / Chest X-ray PA view (1 film)/ TEE / CT angiography (Coronary angiography) Echo AV Canal defect AVSD / AV Canal Defect repair 35.71251,60,000 Echo/ ECG/ Chest X-ray PA view (1 film)/ TEE / CT angiography Echo Ventricular Septal Defect (VSD) VSD Device Closure with PDA device 35.532675,000 Echo/ ECG / Chest X-ray PA view (1 film) Echo, ECG, Procedure CD VSD Device Closure with VSD device 35.532795,000 Echo/ ECG / Chest X-ray PA view (1 film) Echo, ECG, Procedure CD

37. Patent Ductus Arteriosus (PDA) PDA Device Closure35.83.23075,000 Echo/ ECG/ Chest X-ray PA view (1 film) Echo-showing Stent n Situ, Chest X-ray PA view (1 film), ECG, Procedure CD, Device empty pouch PDA coil closure: single coil 35.83.33130,000 Echo/ ECG/ Chest X-ray PA view (1 film) Echo-showing Stent In Situ, Chest X-Ray PA View (1 film), Procedure CD, Device empty pouch PDA coil closure: multiple coil 35.83.43240,000 Echo/ ECG/ Chest X-ray PA view (1 film) Echo-showing Stent in Situ, Chest X-ray PA view (1 film), ECG, Procedure CD, Device empty pouch Surgical closure of PDA (PDA ligation) 35.833345,000 Echo/ ECG / Chest X-ray PA view (1 film) Scar photo/ Echo/ ECG / Chest X-ray PA View (1 film) PDA stenting35.83.13480,000 Echo/ ECG/ Chest X-ray PA view (1 film)/ TEE Echo-showing Stent In Situ, Chest X-ray PA view (1 film), ECG Truncus Arteriosus Truncus Arteriosus Surgery 35.83351,50,000 Echo/ ECG/ Chest X-ray PA view (1 film)/ CT angiography Echo, ECG, Procedure CD TAPVCSurgical correction of TAPVC 35.82361,50,000 Echo/ ECG / Chest X-ray PA view (1 film)/ TEE)/ CT angiography Echo-showing Stent In Situ, Chest X-ray PA view (1 film) VSD Device Closure with VSD device in infants 35.5328125,000 Echo/ ECG / Chest X-ray PA view (1 film) Echo, ECG, Procedure CD

38. CHD (- cont-) Tetrology of Fallot (TOF) Total correction of TOF 35.81371,50,000 Echo/ ECG/ CT angio/ Chest X-ray PA view (1 film)/ MRI angio/Cardiac CATH Echo-showing Stent In Situ, Chest X-ray PA view (1 film), ECG Systemic Pulmonary Shunts with graft 393860,000 ECG/ Echo/ CT angiography/ Cardiac CATH Echo-showing Graft In Situ, Procedure CD, Scar photo, Chest X-ray PA view (1 Film) Pulmonary Atresia / Open pulmonary valvotomy 35.133990,000 Echo/ ECGEcho, ECG, Procedure CD, Chest X-Ray PA View (1 film) Pulmonary Stenosis Balloon pulmonary valvotomy 35.034040,000 Echo/ ECGEcho-Showing Stent In Situ, Chest X-ray PA view (1 film), ECG, Procedure CD Tricuspid Atresia / Tricuspid Stenosis and Ebstein’s Anomaly Glenn procedure35.94411,00,000 ECG/ Echo/ CT angiography/ Cardiac CATH Echo-showing Graft In Situ, Procedure CD, Scar photo, Chest X-Ray PA view (1 film) Fontan procedure35.94421,70,000 ECG/ Echo/ CT angiography/ Cardiac CATH Echo-showing Graft In Situ, Procedure CD, Scar photo, Chest X-Ray PA view (1 film) Aortic valve Stenosis Aortic valve replacement (with valve) 35.23431,45,000 Echo/ ECG/ Chest X-ray PA view (1 film)/ Cardiac CATH/ TEE Echo-showing Stent In Situ, Procedure CD Aortic valve replacement (with Bioprosthetic valve) 35.22.3441,60,000 Echo/ ECG/ Chest X-ray PA view (1 film)/ Cardiac CATH/ TEE Echo-showing Stent In Situ, Chest X-ray PA view (1 film), Procedure CD Open aortic valvotomy 35.114590,000 Echo/ ECG / CT Angiography / Cardiac CATH Echo, ECG, Procedure CD, Chest X-Ray PA View (1 film)

39. CHD (- cont-) Aortic valve Stenosis Ross procedure without conduits 35.22.1461,20,000Echo/ ECG/ CT angiography/ Cardiac CATH/ Chest X-ray PA view (1 film)/ MRI angiogram Echo-showing Prosthetic Ring In Situ CHD (- cont-) Aortic valve Stenosis (-cont-) Ross procedure with conduits 35.22.1471,55,000Echo/ ECG/ CT angiography/ Cardiac CATH/ Chest X-ray PA view (1film)/ MRI angiogram Echo-showing Prosthetic Ring In Situ Balloon aortic valvotomy 35.014840,000Echo/ TEE/ Chest X-ray PA view (1 film)/ ECG Echo-showing Stent In Situ, Chest X-ray PA view (1 film), ECG Hypoplastic Left Heart Syndrome Surgery not covered under RBSK Transposition of the great arteries (TGA) TGA Arterial Switch35.84491,55,000Echo/ CT scan Chest without contrast/ CT angiography / Chest X-ray PA view (1 film) Chest X-ray PA view (1 film), Echo TGA Sennings Procedure 35.91501,55,000Echo/ CT scan Chest without contrast/ CT angio Echo, Chest X-ray PA view (1 film) TGA Mustards Procedure 35.91511,55,000Echo/ CT scan Chest without contrast/ CT angio Chest X-ray PA view (1 film), Echo CHD (- cont-) Coarctation of the aorta (COA) Coarctation dilatation 39.55240,000Echo/ CT angiography/ Chest X-ray PA view (1 film) Doppler

40. CHD (-cont- ) Coarctation of the aorta (COA) Coarctation dilatation with stent 39.55380,000Echo/ CT angiography/ Chest X-ray PA view (1 film) Doppler Coarctation aorta repair with graft 39.5541,00,000Echo/ CT angiography, Color doppler sonoraphy/ Chest X-ray PA view (1 film) Color doppler sonography single study, Scar photo Coarctation aorta repair without graft 39.55570,000Echo/ CT angiography/ Chest X-ray PA view (1 film) Color doppler sonography single study, Scar photo 2Rheumatic Heart Disease* Mitral valve Stenosis Closed mitral valvotomy 35.026340,000Echo/ ECG/ Chest X-ray PA view (1 film) Echo, Chest X-ray PA view (1 film) Open mitral valvotomy 35.12641,10,000Echo/ ECG/ Chest X-ray PA view (1 film) Echo-showing Stent In Situ, Chest X-ray PA view ( 1 film), ECG, Procedure CD Balloon Mitral valvotomy 35.026530,000Echo/ ECG/ Chest X-ray PA view (1 film) Echo-showing Stent In Situ, Chest X-ray PA view (1 film), ECG, Procedure CD Mitral valve replacement (with valve) 35.23661,45,000Echo/ ECG/ Chest X-Ray PA view (1 film)/ Cardiac CATH/ TEE Echo-showing Valve In Situ, Procedure CD

41. 2Rheumatic Heart Disease* Mitral valve Stenosis Mitral valve replacement (Bioprosthetic valve) 35.24671,60,000Echo/ ECG/ Chest X-ray PA view (1 film) Echo-showing Valve In Situ, Procedure CD Mitral valve repair (without Prosthetic ring) 35.24681,10,000Echo/ ECG/ Chest X-ray PA view (1 film) Echo Showing Valve In Situ, Procedure CD Mitral valve repair (with Prosthetic ring) 35.24691,40,000Echo/ ECG/ Chest X-Ray PA View (1 Film) Echo Showing Valve In Situ, Procedure CD Double valve replacement (with valve) 35.20.2701,80,000Echo/ ECG/ Cardiac CATH/ Chest X-ray PA view (1 film) Echo, Chest X-ray PA view (1 film) Double valve replacement (Bioprosthetic valve) 35.20.3712,00,000Echo/ ECG/ Cardiac CATH/ Chest X-Ray PA View (1 Film) Echo Showing Valve In Situ, Procedure CD

42. * The following additional instructions apply for cardiac surgery (Congenital Heart Disease and Rheumatic Heart Disease): 1Procedures on neonates (0-1 month age) will have additional package costs of Rs. 30,000/- besides costs stated above to account for longer ICU/hospital stay, except where already mentioned in the package. 2Cardiac procedures on infants (1month-1 year) will have additional package costs of Rs. 20,000/- besides costs stated above to account for longer ICU/hospital stay, except where already included in the package. 3In general, all cyanotic cases should be operated. Silent PDAs, small shunt lesions and mild valve obstructions should not be operated. 4However, all cardiac procedures will be routed through RBSK identified specialists for preauthorization/preoperative approvals.

43. National Health Mission M.P. Model Costing of Surgical Packages Under RBSK This section outlines the Model costs of surgical packages under RBSK to be used as a reference by the states. A surgical package includes the cost of all pre- operative investigations, cost of surgery, cost of post-operative care including hospital stay and follow up care. (Any additional stay in case of undue and unforeseen complications may be included separately provided proper justification has been made) S. NoHealth Condition DiseaseSurgical Procedure ICD-9 Procedure Code RBSK Procedure Code RBSK Model costing (Rupees) Pre-operati ve Investigati onsPost-operative Evidence DEFECTS AT BIRTH 1 Neural tube defects Anencephaly No surgical procedure is required Spina Bifida Spina Bifida Surgery 2.1 (cerebral) /3.5 (spinal) 135,000 MRI local area/ X-ray dorso -lumbar pine/CT spine (cervical, dorsal, lumbar, sacral) without contrast Clinical photograph (Cl. photo)/ X-ray dorso-lumbar spine Ventriculope ritoneal shunt for hydrocephal us 2.34220,000CT scan head without contrast/ CT angio of brain (head)/MRI brain without contrast/X-ray skull Cl. photo/ Scan head without contrast, CT angio of brain (head)/ MRI brain without contrast, Cerebrospinal Fluid (CSF) analysis cell count 2 Down SyndromeSurgery will depend on associated congenital malformations

44. 4 Talipes (club foot) TalipesCTEV correction - Tenotomy (UL) 83.8471000 Cl. photo CTEV correction - Tenotomy (BL) 83.8481500 Cl. photo CTEV correction - Bracing 83.8492000 Cl. photo CTEV correction - Ponseti (Total) 83.84108000 (Maximum ) Cl. photo 3 Cleft lip and Cleft palate Cleft lipRepair of Cleft lip 27.54315,000 Cl. PhotoCl. photo, Case sheet with operation notes Cleft palate Correction of Cleft palate 27.62418,000 Cl. PhotoCl. photo, Case sheet with operation notes 44 Talipes (club foot) Talipes CTEV correction - Casting (UL) 83.8451,250 Cl. photo CTEV correction - Casting (BL) 83.8462500 Cl. photo

45. 5Developm ental Dysplasia of the Hip (DDH) DDHPavlik Harness93.5111,000X-ray/ Cl. PhotoPhysiotherapy Report Closed reduction and Hip spica 79.7 & 93.51215,000X-ray Hip - AP/lateral view/ Cl. Photo Physiotherapy Report Open reduction and Hip spica 79.8 & 93.51330,000X-ray Hip - AP/lateral view/ Cl. Photo X-ray, Intra-op photo, Case Sheet with operation notes, Open reduction with Femoral Osteotomy 79.8 & 86.89 1445,000X-ray/ MRI / Cl. Photo X ray, Intra-op photo, Case Sheet with operation notes, Physiotherapy Report Open reduction with Femoral and Acetabular Osteotomy 79.8 & 86.89 1560,000X-ray/ MRI / Cl. Photo X ray, Intra-op photo, Case Sheet with operation notes, Physiotherapy Report Femoral Osteotomy77.31630,000X-ray/ MRI / Cl. Photo X ray, Intra-op photo, Case Sheet with operation notes, Physiotherapy Report Acetabular Osteotomy 77.351740,000X-ray/ MRI / Cl. Photo X ray, Intra-op photo, Case Sheet with operation notes, Physiotherapy Report Pelvic Support Osteotomy 77.31840,000X-ray/ MRI / Cl. Photo X ray, Intra-op photo, Case Sheet with operation notes, Physiotherapy Report

46. 6Congenit al Cataract Paediatric Cataract Surgery (Phacoemulsification IOL) 13.71.31920,000Fundus floroscence photo Cl. photo, Fundus floroscence Cataract surgery (Phacoemulsification) 13.412020,000Fundus floroscence photo Cl. photo, Fundus floroscence 9Retinopa -thy of Pre- maturity ROPPhotocoagulation for ROP 14.255610,000Fundus photoCl. photo, Fundus floroscence DEFICIENCIES 10Anaemia especially Severe Anaemia Appropriate medical management 11Vitamin A deficiency (Bitot spot) 12Vitamin D deficiency (Rickets) 13Severe Acute Malnutrition / Stunting 14Goiter

47. CHILDHOOD DISEASES 15 Skin conditions Appropriate medical management 16Otitis MediaAcute and Chronic Suppurative Otitis Media (ASOM and CSOM) Myringotomy with grommet for one ear 20.015710,000PTA/ IA (with stapedial reflex)/ OTO endoscopy/ OTO endoscopy photos PTA, IA (with stapedial reflex), Grommet in position photo Myringotomy with grommet for both ears 20.015815,000PTA/ IA (with Stapedial Reflex)/ OTO endoscopy/ OTO endoscopy photos PTA, IA (with stapedial reflex), Grommet in position photo Myringoplasty19.45916,000PTA Chronic Suppurative Otitis Media (CSOM) Myringoplasty with ossiculoplasty 19.46017,000PTA/ IA (with stapedial reflex)/ X-Ray of both Mastoids/ OTO endoscopy/ OTO endoscopy photos PTA Tympanoplasty / Cortical mastoidectomy 19.56117,000PTA/ IA (with stapedial reflex)/ X-Ray of both Mastoids/ OTO endoscopy/ OTO endoscopy photos X ray, PTA, Scar and graft photos Radical / Modified radical Mastoidectomy 20.46218,000PTA/ IA (with stapedial reflex)/ X-Ray of both Mastoids/ OTO endoscopy/ OTO endoscopy photos X ray, PTA, Scar and graft photos, IA (with stapedial reflex), X-ray both mastoids after 6 weeks, Scar photo

48. 18Reactive Airway DiseaseAppropriate medical management 19Dental Caries Extraction of Tooth23.0172200X ray/ Intra Oral Periepical (Iopa) / RVG (Radiovisiography) X ray, Iopa/ RVG Dental Caries (-cont-) Application of Pit & Fissure Sealants Pedo Full mouth) 23.2.173300Cl. photo/ RVGCl. photo, Iopa/ RVG Amalgam Restoration Per Tooth 23.2.274150X-ray/ IopaX-ray, Iopa/ RVG Temporary Filling Per Tooth 23.2.375100X-ray/ photo/ IopaX-ray/ photo, Iopa/ RVG Tooth Coloured Restoration Per Tooth (GIC) 23.2.476200X-ray/ photo/ IopaX-ray/ photo, Iopa Tooth Coloured Restoration Per Tooth (Composite) 23.2.477250X-ray/photo/ IopaX-ray/photo, Iopa Flouride Varnish Application (Pedo Full mouth) 23.4.178150Cl. PhotoIntra-op photo Atraumatic Restorative Treatment 23.4.679200X-ray/ photo/ IopaX-ray/ photo, Iopa Pulpectomy With Ssc (Stainless Steel Crown ) 23.4.780700X-ray/ Iopa /RVGX-ray, Iopa/ RVG Root Canal Treatment – Deciduous Tooth 23.7.181500X-ray/ OPGX-ray, Iopa

49. Dental Caries (-cont-) Anterior Root Canal Treatment 23.7.2821,200X-ray/ IopaX-ray, Iopa Apicocetomy23.7.3832,000X-ray/ IopaX-ray, Iopa Posterior Root Canal Treatment with Permanent Restoration 23.7.5841,800X-ray/ IopaX-ray, Iopa Extraction Of III Molar / Impacted Tooth under L.A 23.19.1852,000X-ray/ OPGX-ray, Iopa/ RVG Surgical Extraction of Tooth23.19.2861,000X-ray/ OPGX-ray, Iopa/ RVG Fabrication & Cementation of Metal Ceramic Crown per unit 23.41.287800Cl. photo/ Iopa/ Lab charges - Model pouring (Gingival mollage Cl. photo, Case sheet with operation notes Placement of Stainless Steel crown perTooth 23.41.488500Cl. photo/ IopaCl. photo, Iopa Metal Post & Core Restoration with Metal Ceramic Crown (Anterior) 23.41.7892,290X-ray & Cl. photo/ Iopa/ Lab charges - Model pouring (Gingival mollage) X-ray & Cl. photo, Iopa, Case sheet with operation notes Treatment with Expansion Plate 23.42.2901,500Cl. photo/ OPG/ Lab charges - Model pouring (Gingival ollage) Cl. photo, OPG

50. Dental Caries (-cont-) Fabrication & Insertion of Removable Appliance (Upper/ Lower ) 23.43.2911,200Cl. photo/ Lab charges - Model pouring (Gingival mollage) Cl. photo, Case sheet with operation notes Fabrication & Insertion of Removable Partial Denture - Single Tooth Anterior) 23.43.492550 (+ 50 per tooth) Cl. photo/ Lab charges - Model pouring (Gingival mollage) Cl. photo, Case sheet with operation notes Fabrication & Insertion of Fixed Space Maintainers / Space Retainer 23.43.6931280Cl. photo/ (OPG/ Lab charges - Model pouring (Gingival mollage) Cl. photo, Intra-op photo, Study model Fabrication & Insertion of Removable Space Maintainers (Pedo) 23.43.7941,000Cl. photo/ OPG/ Lab charges - Model pouring (Gingival mollage) Cl. photo, Case sheet with operation notes Fixed Orthodontics Treatment-Metal Braces for Cleft palate only 24.7.59510,680X-ray & Cl. photo/ OPG/ Lab charges Model pouring (Gingival mollage)/ Lateral Cephalogram X ray & Cl. photo, OPG, Lab charges - Model pouring (Gingival mollage), Lateral Cephalogram Fabrication & Insertion of Feeding Plate (Acrylic) 24.7.8961,200Cl. photo/ OPG/ Lab charges - Model pouring (Gingival mollage)

51. Dental Caries (-cont-) Fabrication & Insertion of Obturator - Acrylic 24.7.9971,200Cl. photo/ Lab charges - Model pouring (Gingival mollage)/ RVG Cl. Photo, Case sheet with operation notes Fabrication & Insertion of Obturator & Speech Bulb-Acrylic 24.7.10981,500Cl. photo/ Lab charges - Model pouring (Gingival mollage)/ RVG Cl. photo, Case sheet with operation notes Incision & Drainage of Simple Abscess (per Tooth) 27.199500Cl. photo/ OPG/ Cl.Photo Cl. photo, Iopa, Intraop photo Incision & Drainage of Facial Abscess Under LA 27.31002,500X-ray & Cl. photo/ OPG X-ray & Cl. photo, Iopa, Intra-op photo Oral Prophylaxis - calculi (Upper/ Lower) 96.54.2101250Cl. Photo Dental IOPA X ray 10250 X ray 21Vision Impairme nt Strabism us Two or three muscles surgery 15.410411,000Cl. Photo

52. 20Convulsive DisordersAppropriate medical management DEVELOPMENTAL DELAYS 21Vision Impairment StrabismusSingle muscle surgery15.2.1038,500Cl. Photo Two or three muscles surgery 15.410411,000Cl. Photo

53. REPORTING FORMATS

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58. Expectation from Private Hospitals  All accredited hospital should send the report in attached format every month on mail to RBSK division (ddrbskmpnrhm@gmail.com).  All child should be treated as per model costing package, no additional money demand from child by hospital is illegal.  Special care should be provided from hospital to all child.  All hospital receive the permission for treatment (Disease wise) from Department of public health and family welfare.  Timely submit the U.C. every month in attached prescribed format.

59. Thank You NATIONAL HEALTH MISSION MADHYA PRADESH