Listing More Private Hospitals under PM-JAY

• 11 Apr 2020

Why in News

The National Health Authority has launched an express empanelment process called Hospital Empanelment Module (HEM) Lite to bring a large number of private hospitals under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY).

• 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.

Key Points

• With the launch of express empanelment process, 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 Covid -19 infection.
• The mechanism will also help in empanelling dedicated Covid-19 hospitals.
• 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.
• Using the HEM Lite process, it will take less than one 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 the process of approvals by concerned authorities is expeditious.
• 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 government recently decided to bring testing and treatment of covid-19 under AB PM-JAY scheme.
• The State Health Agency (SHA) 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, etc.

Pradhan Mantri Jan Arogya

• PM-JAY offers a sum insured of Rs.5 lakh per family for secondary care (which doesn’t involve a super specialist) as well as tertiary care (which does).
• It is an entitlement-based scheme that targets the beneficiaries as identified by latest Socio-Economic Caste Census (SECC) data. Once identified by the database, the beneficiary is considered insured and can walk into any empanelled hospital.
• The insurance cost is shared by the centre and the state mostly in the ratio of 60:40.
• Empanelled hospitals agree to the packaged rates under PM-JAY—there are about 1,400 packaged rates for various medical procedures under the scheme.
  
  • These packaged rates also mention the number of average days of hospitalization for a medical procedure and supporting documents that are needed.
  • These rates are flexible, but once fixed hospitals can’t change it and under no circumstances can they charge the beneficiary. The scheme also has prescribed a daily limit for medical management.
• The National Health Agency has been constituted as an autonomous entity under the Society Registration Act, 1860 for effective implementation of PM-JAY in alliance with state governments.
• The State Health Agency (SHA) is the apex body of the State Government responsible for the implementation of AB PM-JAY in the State.

Source: TH