Ayushman Bharat Mission rates matched with state government health insurance schemes to allay fears of hospitals
The decision will provide a major relief to hospitals that were finding the new central rates much lower than what they were entitled for providing treatments under state level schemes and CGHS programmes.
The governing council of Ayushman Bharat National Health Protection Mission (AB-NHPM) has decided to allow state governments to retain the package rates they had negotiated with healthcare providers for their respective state level health insurance programmes even after they integrate into the new flagship national scheme.
The decision will provide a major relief to hospitals that were finding the new central rates much lower than what they were entitled for providing treatments under state level schemes and Central Government Health Scheme (CGHS) programmes.
States like Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, Telangana, Maharashtra, Gujarat, Rajasthan and West Bengal have well established state level health insurance scheme to protect their poor. Where ever AB-NHPM package rates are lower than what they have been offering so far, they will have the flexibility to opt for the higher rate.
The governing council meeting, held under the chairmanship of Union Health Minister J P Nadda with state health ministers as its members last week, also decided to retain package rates until the initial contract with the healthcare provider gets over in a year. The National Health Agency that implements the scheme and NITI Aayog, the apex advisor to the programme, will generate sufficient cost based data within the time frame to see if uniform rates can be introduced over a period of time.
While the decision will help ease the existing confusion and fear regarding the package rates offered under the new programme, hospitals that are interested in enrolling for the scheme in states where there is no existing health protection, will have to go by the AB-NHPM rate.
AB-NHPM has announced package rates for 1,350 procedures with in-built flexibilities to offer higher rates for teaching hospitals, research institutions and hospitals in specifically identified 111 backward districts of India.
AB-NHPM aims to provide health protection to over 10 crore poor, deprived rural families and identified occupational categories of urban workers' families as per the latest Socio Economic Caste Census (SECC) data, both rural and urban (about 50 crore beneficiaries).
AB-NHPM will have a defined benefit cover of Rs 5 lakh per family per year (on a family floater basis). This cover will be able to take care of almost all secondary care and most of tertiary care procedure. To ensure that nobody is left out (especially women, children and elderly), there will be no cap on family size and age in the Mission. The scheme would be cashless and paperless at any empanelled hospital. The beneficiaries shall not be required to pay any charge for the hospitalisation expenses. The benefit also includes pre and post-hospitalisation expenses. The scheme is an entitlement based and entitlement of the beneficiary is decided on the basis of family being figured in SECC database.
The official roll out of the programme is expected to be announced by the Prime Minister on August 15, after the IT platform that enables smooth functioning of the scheme is tested for its readiness.