MoS Health Apprises Lok Sabha on Initiatives to Expand Hospital Network Under AB PMJAY

New Delhi: The Ministry of Health and Family Welfare has recently informed the Lok Sabha about the details of hospitals that have been empanelled and de-empanelled under the AB-PMJAY scheme. These details are presented on a state-wise and year-wise basis, ensuring transparency in the selection of healthcare facilities for the program.

Both public and private hospitals are selected based on their ability to meet the program’s standards, and they are periodically reviewed for performance.

Furthermore, the Ministry emphasized that timely claim settlements are a key performance indicator for the success of AB-PMJAY. The State Health Agencies are responsible for ensuring that these claims are processed efficiently and that funds are disbursed promptly. Regular review meetings are conducted at the state level to ensure smooth claims settlement and to address any issues that may arise.

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The minister was responding to the questions raised by Shri Benny Behanan, Shri Vijay Kumar Hansdak, and Shri Hibi Eden about the details of public/private hospitals empanelled/de-empanelled under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), State/year-wise;

They further seeks to know whether the Government is aware of the fact that private hospitals are refusing treatment under AB-PMJAY due to delays in fund disbursement and if so, the details thereof; the measures implemented to monitor and address complaints related to empaneled hospitals under AB-PMJAY particularly regarding refusal of service or denial of benefits to eligible beneficiaries; and

Furthermore, they inquired about the steps taken/proposed to be taken by the Government to increase the number of hospitals under AB-PMJAY.

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Under AB-PMJAY, claims are settled by respective State Health Agencies under the State Government. Timely settlement of claims is one of the key parameters against which scheme performance is measured. The status of claim settlement under the scheme is constantly monitored and review meetings are organized regularly to take stock of the progress with regards to the claims. Further, a three-tier grievance redressal system at the District, State, and National levels has been created to resolve the issues faced by beneficiaries whilst utilizing healthcare services under the scheme. Beneficiaries may file their grievance using different media including the web-based portal Centralized Grievance Redressal Management System (CGRMS), central & state call centers, email, letters to SHA,s, etc. Based on the nature of grievance, necessary action, including providing support to the beneficiaries in availing treatment under the scheme, and resolution of grievances are taken, stated the Minister.

To improve the participation of hospitals, the following actions have been taken:

i. NHA has released a revised health benefit package with an increased number of procedures (1961). Further, rates have been increased for 350 packages and new packages have been added.

ii. Claim settlement is monitored at the highest level and it is ensured that the claim is settled within a defined turnaround time.

iii. Virtual and physical capacity building of hospitals is undertaken.

iv. A hospital-specific call center (14413) has been set up to address their concern on a real-time basis.

v. District Implementation Units (DIU) have been set up to regularly visit empaneled hospitals to understand the issues faced by beneficiaries and hospital.