Lok Sabha Question No. 1011 (UNSTARRED), answered on 2020-09-18
Subject: COVID-19 Treatment under Ayushman Bharat Yojana
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Rakesh Singh, P.R. Natarajan, Bhartruhari Mahtab, Balubhau (Alias Suresh Narayan) Dhanorkar

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 1011 TO BE ANSWERED ON 18 TH SEPTEMBER, 2020

## COVID - 19 TREATMENT UNDER A YUSHMANBHARAT YOJANA

## 1011. SHRI RAKESH SINGH:

SHRI BALUBHAU ALIAS SURESH

NARAYAN DHANORKAR:

SHRI NATARAJAN P.R.:

SHRI BHARTRUHARI MAH TAB:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether rates for the treatment of Covid patients in private hospitals have been fixed under Ayushman Bharat Yojana;
- (b)  if  so,  whether  the  Government  is  aware  that  arbitary  amount  is  being  charged  fo treatment of Corona patients by the private hospitals in the country;
- (c) whether the Go vernment has taken any step to tackle the situation; if so, the details the
- (d)  the  number  of  complaints  received  by  the  Government  for  denial  of  benefits  of  the scheme to the eligible beneficiaries during COVID - 19 pandemic across the country al ong with the action taken thereon, State/UT - wise;
- (e) whether cases of corruption in implementation of the said scheme have come to the not the Government during the said period; if so, the details thereof, State/UT - wise and th  reasons therefor; an d
- (f)  the  steps  taken/being  taken  by  the  Government  for  effective  implementation  of  th scheme across the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI ASHWINI KUMAR CHOUBEY)

- (a)Under Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana (AB - PMJAY), secondary and tertiary  hospitalization  care  is  provided  to  entitled  beneficiaries  through  pre - defined  Health benefit packages (HBPs).

To effectively cover AB - PMJAY beneficiaries for testing and treatment of COV ID-19, packages for 'Testing for COVID -19' and 'Treatment of COVID -19' have been notified.

However,  States/UTs  have  been  given  flexibility  to  modify  the  national  HBPs  relate COVID - 19 based on the guidelines issued by National Health Authority.

(b) & (c) No such complaints have been received under AB - PMJAY. Hospitalization benefits under AB- PMJAY are provided to the entitled beneficiaries in a cashless manner. Further, claims are processed  and paid  based on specified package rates. A package  cons ists of all the costs associated with the treatment, including pre and post hospitalisation expenses.

A  Central  Grievance  Redressal  Management  System  (CGRMS)  has  been  developed  under AB - PMJAY  for  addressing  any  issue  related  to  denial  of  treatment  or  overcharging. beneficiary can lodge grievance on the portal, through national call centre 14555 or throu letter,  fax  etc.  which  is  acknowledged,  recorded,  escalated  &  resolved  a s  per  a  well - defined process. Complaints regarding denial of treatment by an empaneled hospital received thr any medium are immediately assigned to respective State Health Agency for action.

(d) 294 complaints related to denial of treatment for various ailments have been received from 1st April 2020 to 10th September 2020 at the CGRMS of AB - PMJAY and Centralized Public Grievance  Redress  and  Monitoring  System  (CPGRAMS).  Out  of  these,  208  grievances  have been resolved and others are in process of resoluti n. The State/UT - wise numbers of complaints related to denial of benefits under the scheme are provided at Annexure.

During the same period more than 27.2 Lakh beneficiaries have taken treatment under scheme.

(e)  A  dedicated  fraud  and  abuse  control unit  has  been  set  up  at  the  National  level  which continuously tracks utilization data, generation of e -cards and instances of fraud/abuse through monitoring tools on real time basis across India.  However, during the said period, no i of corruptio n related to COVID - 19 hospitalization have been reported.

(f)  Government  has  set  up  National  Health  Authority  to  ensure  the  effective  monitorin implementation of the AB - PMJAY in collaboration with the State Health Agencies (SHA) set up by the implem enting States/UTs. Additionally, District Implementation Units have been setu the districts to direct the implementation at district.

The progress of AB - PMJAY is continuously assessed and monitored on a real time basis. The performance  of  the  scheme is  objectively  evaluated  in  terms  of  e - cards  issued,  number  of hospital admissions, quality of treatment provided, timely settlement of claims etc.

Additionally,  review  meetings  are  conducted  with  the  stakeholders,  including  State  H Agencies,  on  a  periodic  basis.  Necessary  interventions  based  on  the  feedback  regardin scheme implementation are being made.

Other steps taken to ensure the eff ective implementation of the scheme are at the Annexure II.

## Annexure I

| State/UT wise details of grievances received related to denial of services under st April to 10 th September 2020   | State/UT wise details of grievances received related to denial of services under st April to 10 th September 2020   | State/UT wise details of grievances received related to denial of services under st April to 10 th September 2020   | State/UT wise details of grievances received related to denial of services under st April to 10 th September 2020   | State/UT wise details of grievances received related to denial of services under st April to 10 th September 2020   | State/UT wise details of grievances received related to denial of services under st April to 10 th September 2020   | State/UT wise details of grievances received related to denial of services under st April to 10 th September 2020   | State/UT wise details of grievances received related to denial of services under st April to 10 th September 2020   |
|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------|
|                                                                                                                     |                                                                                                                     | Central Grievance Redressal Management System-PM - JAY (CGRMS)                                                      | Central Grievance Redressal Management System-PM - JAY (CGRMS)                                                      | Central Grievance Redressal Management System-PM - JAY (CGRMS)                                                      | CPGRAMS                                                                                                             | CPGRAMS                                                                                                             | CPGRAMS                                                                                                             |
| Sl. No                                                                                                              | Name of the State/UT                                                                                                | Total Number of Grievances received                                                                                 | Total Number of Grievance Resolved                                                                                  | No. of cases in Process                                                                                             | Total Number of Grievances received                                                                                 | Total Number of Grievance Resolved                                                                                  | No. of cases in Process                                                                                             |
| 1                                                                                                                   | Andhra Pradesh                                                                                                      | 1                                                                                                                   | 1                                                                                                                   | 0                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 2                                                                                                                   | Assam                                                                                                               | 1                                                                                                                   | 1                                                                                                                   | 0                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 3                                                                                                                   | Bihar                                                                                                               | 29                                                                                                                  | 12                                                                                                                  | 17                                                                                                                  |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 4                                                                                                                   | Chandigarh                                                                                                          | 2                                                                                                                   | 2                                                                                                                   | 0                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 5                                                                                                                   | Chhattisgarh                                                                                                        | 4                                                                                                                   | 0                                                                                                                   | 4                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 6                                                                                                                   | Gujarat                                                                                                             | 7                                                                                                                   | 5                                                                                                                   | 2                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 7                                                                                                                   | Haryana                                                                                                             | 56                                                                                                                  | 48                                                                                                                  | 8                                                                                                                   | 1                                                                                                                   | 1                                                                                                                   | 0                                                                                                                   |
| 8                                                                                                                   | Himachal Pradesh                                                                                                    | 1                                                                                                                   | 1                                                                                                                   | 0                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 9                                                                                                                   | UT of Jammu And Kashmir and UT of Ladakh                                                                            | 2                                                                                                                   | 2                                                                                                                   | 0                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 10                                                                                                                  | Jharkhand                                                                                                           | 36                                                                                                                  | 22                                                                                                                  | 14                                                                                                                  | 3                                                                                                                   | 1                                                                                                                   | 2                                                                                                                   |
| 11                                                                                                                  | Karnataka                                                                                                           | 6                                                                                                                   | 6                                                                                                                   | 0                                                                                                                   | 1                                                                                                                   | 1                                                                                                                   | 0                                                                                                                   |
| 12                                                                                                                  | Kerala                                                                                                              | 2                                                                                                                   | 1                                                                                                                   | 1                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 13                                                                                                                  | Madhya Pradesh                                                                                                      | 28                                                                                                                  | 26                                                                                                                  | 2                                                                                                                   | 1                                                                                                                   | 0                                                                                                                   | 1                                                                                                                   |
| 14                                                                                                                  | Maharashtra                                                                                                         | 3                                                                                                                   | 2                                                                                                                   | 1                                                                                                                   | 2                                                                                                                   | 2                                                                                                                   | 0                                                                                                                   |
| 15                                                                                                                  | Manipur                                                                                                             | 1                                                                                                                   | 0                                                                                                                   | 1                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 16                                                                                                                  | Nagaland                                                                                                            | 1                                                                                                                   | 1                                                                                                                   | 0                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 17                                                                                                                  | NHCP                                                                                                                | 1                                                                                                                   |                                                                                                                     | 1                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 18                                                                                                                  | Punjab                                                                                                              | 3                                                                                                                   | 2                                                                                                                   | 1                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 19                                                                                                                  | Rajasthan                                                                                                           | 2                                                                                                                   | 2                                                                                                                   | 0                                                                                                                   |                                                                                                                     |                                                                                                                     |                                                                                                                     |
| 20                                                                                                                  | Tamil Nadu                                                                                                          | 3                                                                                                                   | 3                                                                                                                   | 0                                                                                                                   | 3                                                                                                                   | 2                                                                                                                   | 1                                                                                                                   |
| 21                                                                                                                  | Uttar Pradesh                                                                                                       | 71                                                                                                                  | 47                                                                                                                  | 24                                                                                                                  | 3                                                                                                                   | 1                                                                                                                   | 1                                                                                                                   |
| 22                                                                                                                  | Uttarakhand                                                                                                         | 17                                                                                                                  | 13                                                                                                                  | 4                                                                                                                   | 3                                                                                                                   | 2                                                                                                                   | 1                                                                                                                   |
|                                                                                                                     | Total                                                                                                               | 277                                                                                                                 | 198                                                                                                                 | 79                                                                                                                  | 17                                                                                                                  | 10                                                                                                                  | 7                                                                                                                   |

## Steps taken for effective implementation of the Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana

- Drives of e - cards generation have been undertaken in States/UTs in a mission mode
- 'Open BIS policy'  has been devised which enables States to engage services of different public or private entities in addition to the network of CSC VLEs and PMAM to facil the beneficiary identification pro cess.
- Further, Government of India has directed all the Ministry and departments to emp all public hospitals with AB - PMJAY.
- Based on the feedback received from various stakeholders, the Health Benefit Packa under the scheme have been rationalised to HBP 2.0
- States/UTs have been requested to empanel additional hospitals in their jurisdictio is in addition to the 23,323 hospitals that have already been empanelled under th -PMJAY.
- A comprehensive media and outreach strategy to spread awa reness and empowering the beneficiaries about their entitlements and rights under the scheme has been followed
- Further, social media platforms are also being utilised to reach out to the second primary audiences including the intended beneficiari es and other stakeholders. Outreach programme  like  school  contact  program,  activation  programs  at  village  level, campaigns etc. are also being undertaken suitably in consultation with respective Health Agencies.
- National Anti - Fraud Unit (NAFU) h as been created at National Health Authority (NHA) for overall monitoring and implementation of anti - fraud framework supported by State Anti - Fraud  Units  (SAFU)  at  State  level.  The  NAFU  works  in  close  coordination  with SAFU to identity and act against erran t entities.
- To ensure that disputes and grievances involving beneficiaries, healthcare provide other stakeholders under AB - PMJAY are resolved in an efficient, transparent and time -bound  manner,  Grievance  Redressal  Guidelines  have  been  developed  and a  Central Grievance Redressal Management System has been established.