NHA launches express empanelment for private hospitals for serious illnesses under AB PM-JAY

New Delhi: The National Health Authority has launched express empanelment to bring large number of private hospitals under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to ensure continued essential treatment for serious illnesses such as cancer and heart ailments. This is a significant follow-up call taken by the Government of India to its recent decision to bring testing and treatment of COVID-19 under AB PM-JAY scheme as per protocols and guidelines of ICMR, Ministry of Health and Family Welfare and the State Governments.

During the current situation of Novel Coronavirus (COVID -19) outbreak, many medical colleges, civil hospitals and district hospitals which were otherwise treating bulk of AB PM-JAY patients are being converted as dedicated COVID-19 facilities in States. 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 inpatient services without the fear of contracting the infection. The mechanism will also help in empaneling dedicated COVID-19 hospitals as well. Hospitals can empanel themselves for a temporary period of 3 months through a simpler, user friendly online system available on the scheme’s website .

Dr. Indu Bhushan, CEO Ayushman Bharat PM-JAY and National Health Authority said, “To ensure that treatment of AB PM-JAY patients doesn’t suffer as many currently empaneled hospitals are converting themselves to dedicated COVID-19-only facilities, 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. 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. 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 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.

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