Lok Sabha Question No. 1802 (UNSTARRED), answered on 2022-12-16
Subject: Challenges in the Implementation of the Ayushman Bharat Yojana
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Girish Chandra

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

## LOK SABHA UNSTARRED QUESTION NO. 1802 TO BE ANSWERED ON 16 TH DECEMBER, 2022

## CHALLENGES IN THE IMPLEMENTATION OF THE AYUSHMAN BHARAT YOJANA

## 1802.  SHRI GIRISH CHANDRA:

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

- (a) whether the Government is facing any challenges with regards to the implementation of the Ayushman Bharat Yojana;
- (b)  if  so,  the  details  thereof  along  with  measures  taken/proposed  to  be  taken  for  effective implementation of the Yojana;
- (c)  whether  the  Government  is  contemplating  toprovide  the  benefits  of  the  said  Yojana  to  the deprived beneficiaries by conducting a nationwide survey again; and
- (d) if so, the details thereof?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

(a) to (d): Ayushman Bharat - Pradhan Mantri Jan ArogyaYojana (AB-PMJAY) launched on 23.09.2018 is the world's largest insurance/assurance scheme. The scheme provides health coverage of Rs. 5 lakh per beneficiary family per annum to approximately 10.74 crore poor and vulnerable families identified on the basis of select deprivation and occupational criteria in rural and urban areas respectively as per SECC database of 2011. Beneficiary database is defined under the scheme. However, in order to overcome the problem of missing eligible beneficiary  families,  Ministry  of  Health  &  Family  Welfare  has  issued  instructions  to States/UTs on 23.06.2022 tomake use of their own datasets for identification of beneficiaries. Government of India shall, however, provide its share of funding for all such beneficiaries limited to the number of eligible households as per SECC 2011 database.

Details of measures taken for effective implementation of the scheme are at Annexure.

## Details of measures taken for effective implementation of the scheme:

-  Aapke Dwar Ayushman: ADA campaign implemented by NHA since January 2021 enlisted the services  of  grassroots  functionaries  which  resulted  in  the  verification  of  more  than  4.7  Crore individuals.
-  Aapke  Dwar  Ayushman  2.0  has  been  relaunched  with  special  emphasis  on  saturating  the  card generation  process,  with  the  goal  of  issuing  an  additional  20  crore  cards  by  the  end  of  current Financial Year totaling approximately 40 crore Ayushman cards.
-  Green Channel Payment (GCP): NHA has introduced an expedited claim settlement mechanism to incentivize EHCPs with a record of robust participation, sound credentials and healthy record of claim settlement. The GCP has been implemented as pilot in identified EHCPs from Uttar Pradesh. Further, Karnataka has rolled out GCP in all public hospitals.
-  Beneficiary Facilitation Agencies (BFA): BFAs were introduced by National Health Authority to streamline  the  implementation  of  AB  PM-JAY  at  empanelled  public  hospitals.  BFAs  are incentivized  to  increase  scheme  uptake  by  attending  to  the  needs  of  beneficiaries,  screening  for potential beneficiaries and timely submission of treatment claim.
- Number  of  States/UTs  implementing  BFA : 8  States  viz.  Bihar,  Madhya  Pradesh,  Rajasthan, Uttarakhand, Tripura, Himachal Pradesh, Punjab Maharashtra.
-  PM-JAY Mobile App -  PM-JAY mobile is available on google play store. Key features include locating  nearby  empanelled  hospitals,  check  eligibility,  wallet  transactions  and  status,  treatment details etc.
-  Convergence - The Health assurance/insurance schemes under ESIC, PSU (Coal India Ltd.), CGHS for  pensioners,  CAPF,  BoCW,  Rashtriya  Arogya  Nidhi  (RAN),  Health  Minister's  Discretionary Grants (HMDG) and Scheme for Transgender have been converged with AB PM-JAY to provide services to the beneficiary families of AB PM-JAY.
-  Grievance  Redressal -  NHA  established  a  Central  Grievance  Redressal  Management  System (CGRMS). Any complaint received  either  through  national  call  centre  or  on  grievance  redressal portal  (https://cgrms.PM-JAY.gov.in/)  or  through  any  other  medium  are  immediately  assigned  to respective State Grievance Nodal Officer designated at each SHA for necessary action.
- As of 6 th December 2022, 99% of the total registered grievances (3.02 lakh) have been resolved.
-  Fraud Control - National Anti-Fraud Unit (NAFU) has been created at NHA for overall monitoring and  implementation  anti-fraud  framework  supported  by  State  Anti-Fraud  Units  (SAFU)  at  State level.  Further,  NHA  is  using  Artificial  Intelligence  and  Machine  Learning  to  detect  fraud proactively and identify suspicious transactions.
- Impact of Anti-fraud initiatives-
-  Ayushman Cards Disabled- 5.3 Lakh
-  Hospital De-empanelled- 210
-  Hospitals suspended- 188
-  Penalty Levied- Rs. 21 Crores
-  Penalty Recovered- Rs 9.5 Crores
-  Health Benefit Packages - The recently launched HBP 2022 consists of 1,949 procedures including secondary, tertiary and palliative care across 27 specialties. The features of HBP 2022 are:
-  One new specialty of Palliative care has been introduced
-  A total of 365 treatment procedures have been added
-  High  end  procedures  such  as  bone  marrow  transplant  and  cochlear  implant  surgery  have  been introduced
-  Day  care  packages  for  mental  health  which  involves  psychometric  evaluation,  investigations, counselling have been added.
-  High end drugs, consumables, and diagnostics have been unbundled from the per-bed day cost of medical packages.

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