Adopt Clinical Establishment Act, Health Ministry urges states

New Delhi: The Union Health Ministry has urged states to adopt the Clinical Establishment Act, which aims to streamline healthcare services in India, stating they are the "most important partners" in rolling out of the free health insurance scheme that offers cover for 10 crore poor families.

The Ayushman Bharat-National Health Protection Mission (AB-NHPM), expected to be launched anytime after July, aims to provide a coverage of Rs 5 lakh per family annually to 10 crore families belonging to vulnerable sections of society.

The health ministry's reminder to all states came as it wants states to adopt the Act before the launch of the AB-NHPM, to ensure appropriate checks and balances are put in place and maximum benefit is obtained by the beneficiaries.

In a letter to all states, the health secretary said states should adopt the Act, which is applicable to all types of clinical establishments in public and private sectors.

"The state governments are the most important partners under this scheme sharing 40 percent of the amount and implementing the scheme, therefore, an appropriate oversight and monitoring mechanism also needs to be put in place," the health ministry's letter stated.

About five states including Arunachal Pradesh, Rajasthan, Assam and Jharkhand and all Union territories except the NCT of Delhi have adopted and implemented the Act.

Sikkim, Bihar, Mizoram, Uttar Pradesh and Uttarakhand have adopted the Act, but not yet implemented it.

The letter said state governments may consider to bring a state specific legislation as has been done by some states.

The ministry wants to complete sharing of the latest Socio-Economic Caste Census(SECC) data with states by April 30, testing of IT systems and hospital empanelment by July 31.

States will be allowed to implement the scheme through insurance companies or Trust/Society or a mixed model and it will be an entitlement-based scheme with entitlements decided on the basis of deprivation criteria in the SECC database.

Deprivation categories in rural areas include, families having only one roof with kutcha walls and roof, families having no adult member between age 16-59, SC/ST households and landless households deriving a major part of their income from manual casual labour.

Also, families without shelter, destitute, those living on alms, manual scavenger families, primitive tribal groups, legally released bonded labour in rural areas will be included.

For urban areas, 11 defined occupational categories, including rag-pickers, beggars, domestic workers, cobblers, hawkers, construction workers, plumbers, painters and security guards are entitled under the scheme.

To control the cost factor, payment for treatment will be done on package rate basis and it will be cashless transaction for the beneficiaries.

In the first phase of the launch, the packages will cover mostly all life-saving surgeries except for organ-transplant.

The AB-NHPM is states to be the world's largest government-funded healthcare insurance programme.