NHA launches empanelment for private hospitals under Ayushman Bharat PM-JAY

The National Health Authority (NHA) on April 10 launched express empanelment to bring a large number of private hospitals under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). This has been done to ensure continued essential treatment for serious illnesses such as cancer and heart ailments. This is regarded as a follow-up call taken by the Centre to its recent decision to bring testing and treatment of Covid-19 under AB PM-JAY scheme as per protocols and guidelines of ICMR, Health and Family Welfare Ministry and the state governments.

During the currentnovel coronavirus outbreak, many medical colleges, civil and district hospitals that were otherwise treating the bulk of AB PM-JAY patients are being converted as dedicated Covid-19 facilities, as per the official release.

With the launch of this new mechanism 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 in-patient services without the fear of contracting the infection. The mechanism will also help in empanelling dedicated Covid-19 hospitals as well. Hospitals can empanel themselves for a temporary period of three months through an online system available on the scheme’s website www.pmjay.gov.in .

Dr Indu Bhushan, CEO Ayushman Bharat PM-JAY and National Health Authority said, “ As part of our effort in enhancing our capacity for serving beneficiaries of AB PM-JAY, we have designed and launched express empanelment of private hospitals on a temporary basis to strengthen the supply of care under the scheme.”

She added, “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 the patients.”

The State Health Agency (SHA), which is the apex body of the state government responsible for the implementation of AB PM-JAY, will sign an MoU with the express empanelled hospital for three months only.

After this period, the SHA can continue with the empanelment on mutual agreement between the hospital and SHA but only after the empanelment process is followed.

The official release mentioned that 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 to ensure that the rest of the process of approval by concerned authorities is expeditious.

Ayushman Bharat informed that for the easy reference, the empanelment guidebook has also been provided. In case hospitals get stuck anywhere, they can call the NHA representative for the prompt response and extend full support on submission of the form.

The scheme covers more than 1,500 health benefits 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.

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

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