Lok Sabha Question No. 4315 (UNSTARRED), answered on 2024-12-20
Subject: Delay Payment to Private Hospitals under AB-PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Smt. Sajda Ahmed

## GOVERNMENTOFINDIA MINISTRYOF HEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH AND FAMILYWELFARE

## LOK SABHA UNSTARRED QUESTION NO. 4315 TO BE ANSWERED ON 20 TH DECEMBER, 2024

## DELAY PAYMENT TO PRIVATE HOSPITALS UNDER AB-PMJAY

## 4315. SMT. SAJDA AHMED:

Will the Minister of HEALTHAND FAMILYWELFARE be pleased to state:

(a) whether the Government has taken note that private sector hospitals have pulled back/withdrawn from AB-PMJAY due to low funding, if so, the details thereof;

(b) steps taken/proposed to be taken by the Government to address the issue of payment delays and insufficient fund allocations by the Government that have led to reduced participation of private hospitals in the scheme;

(c) whether the Government has conducted any assessments of the reduction in beneficiaries ' access to healthcare services under AB-PMJAY due to these challenges and if so, the details thereof, State/UT-wise;

(d) the details of the mechanism in place to ensure timely payments to private hospitals under AB-PMJAY; and

(e) the details of the reforms being proposed/under consideration by the Government to prevent future disruptions in services?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI PRATAPRAO JADHAV)

(a) to (e): Under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), claims are settled by respective State Health Agencies (SHAs). Timely settlement of claims is one of the key parameters against which the scheme performance is measured. Therefore, the status of claim settlement under the scheme is constantly monitored to ensure that claims are settled within defined turnaround time. Necessary action is taken by the National Health Authority wherever there is a delay in claim payment. Additionally, the issue of overdue claims is also taken up regularly during State review meetings. Further, capacity building activities are organised for efficient claims settlement. Another initiative called the Green Channel Payments (GCP) has been launched with the objective to ensure timely payment to the hospitals. Under GCP, partial payment of 50% of the claim amount is automatically released to the hospitals at the time of claim submission, while the balance is released after the normal claim adjudication process.

In order to enhance participation of empaneled hospitals, a two-pronged strategy has been adopted:

1. Expanding the network of hospitals empaneled under AB-PMJAY:

Public health and hospitals being a State subject, State Health Agencies (SHAs) are mandated with the responsibility of empaneling hospitals under AB-PMJAY. Further, States have also been given complete flexibility to change hospital empanelment criteria for deficit regions. Further, National Health Authority (NHA) follows up with prominent corporate hospital chains for empanelment under the scheme.

2. Improving the participation of already empaneled hospitals:
- i. Package rates have been revised under HBP 2022 in which 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 claim is settled within defined turnaround time.
- iii. Virtual and physical capacity building of hospitals are undertaken.
- iv. Ahospital-specific tollfree number (14413) has been introduced to address their concern on a real-time basis.
- v. SHAs have been instructed that District Implementation Units (DIUs) should regularly visit empaneled hospitals to understand their concern and review their participation under the scheme.

*****