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 People wear protective masks as precaution against coronavirus, outside AIIMS hospital in New Delhi. (PTI)
People wear protective masks as precaution against coronavirus, outside AIIMS hospital in New Delhi. (PTI)

Govt launches express empanelment process to bring more pvt hospitals under Ayushman Bharat

  • The government recently decided to bring testing and treatment of covid-19 under AB PM-JAY scheme
  • The eligibility criteria for public hospitals and private hospitals are already defined

NEW DELHI : In a bid to ensure continued essential treatment for cancer and heart ailments under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) amidst covid-19 pandemic, government on Friday launched express empanelment process aiming to bring large number of private hospitals under the scheme.

The move came in the backdrop of the current situation of covid-19 outbreak, when many medical colleges, civil hospitals and district hospitals which were otherwise treating bulk of AB-PMJAY patients are being converted as dedicated covid-19 facilities in States.

With the launch of express empanelment called Hospital Empanelment Module (HEM) Lite, patients suffering from serious illnesses, such as cancer, cardiac issues and diabetes that require continuous treatment, will be able to continue getting inpatient services without the fear of contracting the infection.

The mechanism will also help in empaneling dedicated covid-19 hospitals as well, the National Health Authority (NHA) -- the nodal implementing agency for the health insurance scheme said. Hospitals can empanel themselves for a temporary period of 3 months through a simpler, user friendly online system available on the scheme’s website www.pmjay.gov.in, it said.

The government recently decided to bring testing and treatment of covid-19 under AB PM-JAY scheme as per protocols and guidelines of Indian Council of Medical Research (ICMR), Ministry of Health and Family Welfare and the State Governments.

“To ensure that treatment of AB PM-JAY patients don’t suffer as many currently empaneled hospitals are converting themselves to dedicated covid-19-only facilities, we have designed and launched express empanelment of private hospitals on a temporary basis to strengthen the supply of care under the scheme," Indu Bhushan, CEO AB PM-JAY and National Health Authority said.

“We have started reaching out to the States, hospital associations and healthcare industry bodies with this new proposal to onboard private hospitals through a simple, quick and seamless system on a temporary basis," said Bhushan adding that these hospitals have the choice whether to provide regular treatment for serious illnesses such as cancer and cardiac illnesses under the scheme or convert themselves into covid-19 only hospitals providing dedicated testing and treatment to covid-19 patients."

The State Health Agency (SHA), which is the apex body of the State Government responsible for the implementation of AB PM-JAY in the State will sign an MoU with express empaneled hospital for three months only. After this period, the SHA can continue with the empanelment on mutual agreement between hospital and SHA but only after the detailed empanelment process is followed i.e. hospital has filled the entire form and District Implementation Unit ( (DIU) and SHA have verified the details and submitted the verification report in the due course of time.

The eligibility criteria for public hospitals and private hospitals are already defined. Using the HEM Lite, will take less than 1 hour for a hospital to fill the application form along with documents. The system has been built in a way to ensure that the rest of process of approval by concerned authorities is expeditious. For your easy reference, empanelment guidebook has also been provided. In case hospitals get stuck anywhere, they can call the NHA representative for prompt response and extend full support on submission of the form.

The scheme covers more than 1500 health benefit packages of procedures pertaining to secondary and tertiary care and hospitals are reimbursed at pre-fixed rates. The package prices are revised periodically and new rates were launched last year. Over and above listed price, there is further incentive available to hospitals up to 39% (cumulative) for NABH entry level/full accreditation, geographical location (metro/aspirational districts) and for running PG courses.

As on date more than 8,804 private hospitals are empaneled under AB PM-JAY across the country and account for 51% of all treatments (96 lakh hospitalizations) and 64% of the hospital admissions amount (Rs.13,000 crore). The claim money is transferred within 15 days from date of submission of documents by hospital and there is a robust system for grievance redressal.

AB-PMJAY is the flagship government scheme that provides a cover of up to Rs. 5 lakhs per family per year, for secondary and tertiary care hospitalization to over 10.74 Crore poor and vulnerable families (about 53 crore beneficiaries).

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