ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND
FAMILY WELFARE
(SHRI ASHWINI KUMAR CHOUBEY)
(a) to (d): The roll out plan of Ayushman Bharat – Health & Wellness Centers (AB-HWCs) as under :
• FY 2018-19 = 15,000
• FY 2019-20 = 25,000 (Cumulative 40,000)
• FY 2020-21 = 30,000 (Cumulative 70,000)
• FY 2021-2022 = 40,000 (Cumulative 1,10,000)
• Till 31st December 2022 = 40,000 (Cumulative 1,50,000)
Services at AB-HWCs are free and universal to all individuals residing in the service area. Against the target of 40,000 AB-HWCs by FY 2019-20, approvals for more than 62,000 AB-HWCs have been given to States/UTs and as per AB-HWC portal, 29214 AB-HWC are functional as on 30.01.2020.
State/UT-wise fund released for implementation of AB-HWCs in 2019-20 is at Annexure I. The state-wise details of footfalls and screening done for hypertension, diabetes and cancer as on 31.01.2020 is at Annexure II.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aims to provide health cover up to Rs 5 lakh per family per annum to around 10.74 crore poor and vulnerable families identified as per Socio Economic Caste Census (SECC) database. As on 04.02.2020, over 80.61 lakh hospital admissions worth Rs. 11285.64 cores have been registered under AB-PMJAY across 32 States/UTs.
The State/UT wise details relating of eligible SECC beneficiary families, e-Cards issued, number of hospital admissions, and fund released is at Annexure III.
As on 04.02.2020, 21,789 hospitals have been empanelled under the scheme. These include public and private single speciality, multi-speciality and super speciality hospitals. The location wise empanelled hospital details are available at PMJAY’s official website www.pmjay.gov.in at the link (https://hospitals.pmjay.gov.in/Search/)
All public hospitals (Community Health Centre and above), in the States implementing AB-PMJAY, are deemed empanelled for providing hospitalization. Further, State Governments, through State Health Agencies, empanel private hospitals within their jurisdiction based on defined criteria and hospital empanelment guidelines to provide care to beneficiaries. Guidelines for empanelment criteria of hospitals have been issued to the States.
The criteria for empanelment is divided into two broad categories:•
(a) General criteria – For hospitals that provide non-specialised general medical and surgical care with or without ICU and emergency services.
(b) Special Criteria (for clinical specialties) – For each specialty, a specific set of criteria has been identified. In order to offer a specialised clinical service, the hospital must have necessary specific infrastructure and human resource in place. Only those hospitals eligible under general criteria can apply for empanelment under this category.
With prior approval, State Governments have the flexibility to revise/relax the empanelment criteria, barring minimum requirements, depending on their local context, availability of providers, and the need to balance quality and access. The detailed criteria for empanelment are available at https://www.pmjay.gov.in/documents.
Based on the proposals received from the States/ UTs, AB-HWC is being implemented in all States/ UTs except UT of Delhi.
The States of Odisha, Telangana, West Bengal and Union Territory of Delhi are not implementing AB-PMJAY. The implementation of scheme was withdrawn by the State Government in West Bengal from January 2019. Government of India has been constantly requesting these State/UT Governments to join the scheme as beneficiaries of these States/UT are deprived of benefits under AB-PMJAY.
AB-PMJAY has a set of 1393 packages across 23 specialties including one unspecified surgical package covering a vast spectrum of acute and chronic conditions. These packages include most of the secondary and tertiary treatment across all critical specialities like cardiology, oncology, neurosurgery, Orthopaedics etc. Details of packages under the scheme are available at the website www.pmjay.gov.in.
(e): Based on forensics and medical audit analysis under AB-PMJAY, certain high-risk packages have been identified. Following key steps have been taken to prevent abuse of these packages:
i. Pre-authorisation is mandatory for these packages.
ii. Most of these packages have been reserved for public hospitals
iii. Suspect triggers under these packages are being sent to the States for appropriate action.
Ayushman Bharat- PMJAY was launched on 23.09.2018. Since its launch, the Action against fraudulent hospitals/entities is as under -
i. More than 440 hospitals have been served Show Cause Notice/suspended/de-empanelled in different states.
ii. Out of these, 205 have been de-empanelled
iii. FIRs have been lodged against 6 hospitals
iv. Amount of penalties levied is more than Rs. 4.6 Crore
(f): Constant communication is maintained with the State Health Agencies for ensuring seamless implementation of the scheme across country. Routine inputs regarding IT system, health benefit packages etc are received from different stakeholders. These feedbacks are evaluated and suitably incorporated, if deemed appropriate.
The progress of the scheme is continuously being assessed and monitored on real time basis. A dashboard with various key performance indicators (KPI) has been designed to constantly monitor the scheme. The performance of the scheme is objectively evaluated in terms of cards issued, number of hospitalization cases, quality of treatment provided, timely payment of claims etc
Also, to ensure that disputes and grievances involving beneficiaries, healthcare provider and other stakeholders are resolved in an efficient, transparent and time bound manner, Grievance Redressal Guidelines have been developed and a Central Grievance Redressal Management System has been established. Grievances can be registered on the portal, through national call centre (14555) or PMJAY website, through mail, letter, fax etc. for resolution as per a well-defined process. Also, a three-tier grievance redressal structure has been setup to ensure timely redressal of grievances at District, State & National level.
(g): Operational guidelines on Ayushman Bharat – Comprehensive Primary Helath Care through Health and Wellness Centres prescribe the human resource requirements in AB-HWCs as below -
Facility Human Resources prescribed (HR)
Sub Centre AB-HWC • Community Health Officer (CHO)
• 2 Multipurpose workers
PHC – AB-HWC • Two Medical Officer
• Staff Nurses
• Lab Technician
• Pharmacist
• Lady Health Visitors
Only those Sub Health Centres and Primary Health Centres that have complied with the above HR norms are being considered as operational AB-HWCs, besides satisfying other functionality criterion prescribed in the Operational Guidelines. To ensure and enable availability of above medical professionals and para medics in AB-HWCs, necessary financial and technical support is being provided to the States under NHM. Besides this, NHM Conditionality framework and mechanisms of additional incentives encourage states to complete recruitment for vacant positions of the necessary human resources at PHC and SHCs being transformed as AB-HWCs.
(h): Under AB-PMJAY claims submitted by empanelled healthcare providers are examined at different levels by experts including doctors. Claims not submitted as per the guidelines are declined by the claim processing team set up by the States. As on 04.02.2020, the State/UT wise details of percentage of claims declined under AB-PMJAY is at Annexure IV. The percentage of claims declined in Srikakulam is 0.75%.
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