Lok Sabha Question No. 98 (STARRED), answered on 2023-12-08
Subject: Empanelment of Hospitals under AB-PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Raksha Nikhil Khadse, Ramcharan Bohra

## GOVERNMENTOFINDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OFHEALTH AND FAMILYWELFARE

## LOK SABHA STARRED QUESTION NO. 98 TO BE ANSWERED ON THE 8 TH DECEMBER, 2023

## EMPANELMENTOFHOSPITALS UNDER AB-PMJAY

## *98. SHRIMATI RAKSHA NIKHIL KHADSE: SHRI RAMCHARAN BOHRA:

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

- (a) the number of Government and private hospitals empanelled to cover the medical treatment under Ayushman Bharat-PM Jan Arogya Yojana, State/UTwise including Maharashtra;
- (b) the funds allocated along with the percentage of the total population of the country benefited and covered under the Scheme;
- (c) the list of the charges fixed for carrying out various medical procedures under the Scheme along with eligibility criteria laid down for availing reimbursement with the empanelled hospitals, State/ UT-wise;
- (d) the details of the claims registered under the Scheme during each of the last three years and the current year, State/UT-wise; and
- (e) whether the diseases such as leprosy, skin diseases and cancer are covered under the said Scheme and if so, the details thereof?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE (DR MANSUKH MANDAVIYA)

- (a) to ( e) A Statement is laid on the Table of the House.

## STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION NO. 98 FOR 8 TH DECEMBER, 2023

Ayushman Bharat Pradhan Mantri - Jan Arogya Yojana (AB PM-JAY) is the largest publicly funded health assurance scheme in the world which aims to provide health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization to 12 Crore families. A total of 26,774 hospitals including 11,733 private hospitals have been empanelled across the country to provide healthcare services to the scheme beneficiaries as on 02.12.2023. With respect to the State of Maharashtra, a total of 1044 hospitals including 836 private hospitals have been empanelled. The State wise details of empanelled hospitals are enclosed as Annexure-1.

The AB PM-JAY provides health cover to families which constitute the bottom 40% of the population. The budget allocated for Ayushman Bharat PM-JAY for the financial year 2023-24 is Rs. 7,200 Crore. With respect to utilization, it may kindly be noted that as on 30.11.2023, approximately, 6 crore hospital admissions worth Rs. 77,298 Crore have been authorised under the scheme.

AB PM-JAY scheme is completely cashless and paperless in nature, without the concept of reimbursement. Beneficiaries can avail treatment with respect to defined packages. The Empanelled Healthcare Providers (EHCPs) are paid based on specified Health Benefit Packages (HBP) with standardised rates. The cost of HBP covers all the costs related to treatment, including but not limited to; drugs, supplies, diagnostic services, physician fees, room charges, surgeon charges, OT and ICU charges, etc.

As per the latest HBP (2022), a total of 1,949 procedures across 27 specialties are available for AB PM-JAY beneficiaries. Further, States/UTs have been given flexibility to add state specific packages over and above national master. Also, they have been provided flexibility to change the cost of the package as per local requirement. National Health Package Master of PM-JAY may be found under : (https://pmjay.gov.in/sites/default/files/2022-04/HBP%202022%20..pdf).

A total of 4.98 crore claims have been submitted for the period between FY 2020-21 and FY 2023-24 as on 30.11.2023. The Financial Year wise details of claims submitted are as follows:

| Financial Year   | Claims Submitted (count)   |
|------------------|----------------------------|
| FY2020-21        | 70.06 Lakh                 |
| FY2021-22        | 1.45 Crore                 |
| FY2022-23        | 1.63 Crore                 |
| FY2023-24        | 1.19 Crore                 |

The FY wise and State wise details of claims submitted are enclosed as Annexure-II

AB PM-JAY provides treatment corresponding to a total of 1,949 procedures under 27 different specialties including diseases such as Cancer, Diabetes, Heart Disease etc. It may kindly be noted that leprosy as package is not included under PM-JAY. However, 26 procedures related to skin diseases and 549 procedures related to Cancer are covered under AB PM-JAY.

Further, to ensure that AB PM-JAY beneficiaries are not denied care for treatments / procedures that do not feature in the HBP, 01 unspecified package has been included in the HBP to avail treatment for such procedures under the scheme. Approximately 34.92 Lakh hospital admissions worth Rs. 6,537 Crore and 1.68 Lakh hospitals admissions worth Rs. 254 Crore have been authorized as on 02.12.2023, under Ayushman Bharat PM-JAY for cancer-related treatment and skin-related treatment respectively.

*****

## State-wise details of Hospitals Empanelled

| State /UTs                  | Public Hospitals (including Govt of India Hospitals)   | Private Hospitals   | Total Hospitals   |
|-----------------------------|--------------------------------------------------------|---------------------|-------------------|
| Andaman And Nicobar Islands | 7                                                      | -                   | 7                 |
| Andhra Pradesh              | 1,391                                                  | 930                 | 2,321             |
| Arunachal Pradesh           | 61                                                     | -                   | 61                |
| Assam                       | 170                                                    | 156                 | 326               |
| Bihar                       | 607                                                    | 329                 | 936               |
| Chandigarh                  | 7                                                      | 20                  | 27                |
| Chhattisgarh                | 1,022                                                  | 535                 | 1,557             |
| Dadra And Nagar Haveli      | 11                                                     | 2                   | 13                |
| Daman And Diu               | 4                                                      | 3                   | 7                 |
| Delhi                       | 34                                                     | 54                  | 88                |
| Goa                         | 15                                                     | 2                   | 17                |
| Gujarat                     | 1,727                                                  | 768                 | 2,495             |
| Haryana                     | 511                                                    | 627                 | 1,138             |
| Himachal Pradesh            | 146                                                    | 103                 | 249               |
| Jammu And Kashmir           | 118                                                    | 121                 | 239               |
| Jharkhand                   | 276                                                    | 306                 | 582               |
| Karnataka                   | 2,962                                                  | 539                 | 3,501             |
| Kerala                      | 202                                                    | 363                 | 565               |
| Ladakh                      | 10                                                     | -                   | 10                |
| Lakshadweep                 | 5                                                      | -                   | 5                 |
| Madhya Pradesh              | 498                                                    | 477                 | 975               |
| Maharashtra                 | 208                                                    | 836                 | 1,044             |
| Manipur                     | 70                                                     | 26                  | 96                |
| Meghalaya                   | 163                                                    | 17                  | 180               |
| Mizoram                     | 90                                                     | 6                   | 96                |
| Nagaland                    | 88                                                     | 23                  | 111               |
| Odisha                      | 23                                                     | 2                   | 25                |
| Puducherry                  | 12                                                     | 18                  | 30                |
| Punjab                      | 213                                                    | 504                 | 717               |
| Rajasthan                   | 953                                                    | 965                 | 1,918             |
| Sikkim                      | 16                                                     | 3                   | 19                |
| Tamil Nadu                  | 930                                                    | 1,154               | 2,084             |
| Telangana                   | 1,021                                                  | 351                 | 1,372             |
| Tripura                     | 148                                                    | 4                   | 152               |
| Uttar Pradesh               | 1,137                                                  | 2,351               | 3,488             |
| Uttarakhand                 | 124                                                    | 134                 | 258               |
| West Bengal                 | 61                                                     | 4                   | 65                |
| Total                       | 15,041                                                 | 11,733              | 26,774            |

## Annexure-II

## Financial year wise and State wise details of Claims submitted

| State/UTs                   | FY 2020-21             | FY 2021-22             | FY 2022-23             | FY 2023-24 (till 30.11.2023)   |
|-----------------------------|------------------------|------------------------|------------------------|--------------------------------|
| State/UTs                   | Claims Submitted Count | Claims Submitted Count | Claims Submitted Count | Claims Submitted Count         |
| Andaman And Nicobar Islands | 307                    | 753                    | 663                    | 328                            |
| Andhra Pradesh              | 4,11,343               | 6,31,389               | 6,83,990               | 4,17,868                       |
| Arunachal Pradesh           | 42                     | 45                     | 923                    | 740                            |
| Assam                       | 92,083                 | 1,73,866               | 2,34,535               | 2,75,595                       |
| Bihar                       | 83,214                 | 1,12,312               | 2,05,367               | 1,75,103                       |
| Chandigarh                  | 5,123                  | 8,178                  | 10,041                 | 10,185                         |
| Chhattisgarh                | 4,90,895               | 8,88,050               | 12,60,384              | 9,45,601                       |
| Dadra And Nagar Haveli      | 14,780                 | 16,064                 | 16,333                 | 14,316                         |
| Daman And Diu               | 4,077                  | 4,455                  | 5,082                  | 3,310                          |
| Goa                         | 139                    | 166                    | 407                    | 1,336                          |
| Gujarat*                    | 2,67,291               | 6,67,324               | 10,07,709              | 4,33,005                       |
| Haryana                     | 1,36,628               | 1,83,293               | 2,79,577               | 3,10,768                       |
| Himachal Pradesh            | 27,893                 | 45,821                 | 60,268                 | 38,188                         |
| Jammu And Kashmir           | 61,850                 | 2,45,947               | 3,77,222               | 2,54,783                       |
| Jharkhand                   | 2,88,913               | 3,21,441               | 4,02,605               | 2,38,911                       |
| Karnataka                   | 6,58,710               | 10,86,009              | 20,30,793              | 17,95,671                      |
| Kerala                      | 10,37,392              | 16,93,019              | 12,17,090              | 4,96,332                       |
| Ladakh                      | -                      | 506                    | 5,088                  | 3,904                          |
| Lakshadweep                 | -                      | 65                     | 421                    | 283                            |
| Madhya Pradesh              | 3,76,210               | 6,99,369               | 11,41,546              | 7,46,270                       |
| Maharashtra                 | 2,30,205               | 2,91,669               | 2,93,529               | 1,33,926                       |
| Manipur                     | 16,076                 | 23,648                 | 38,346                 | 24,179                         |
| Meghalaya                   | 1,23,714               | 1,45,207               | 1,84,801               | 1,24,379                       |
| Mizoram                     | 16,931                 | 13,814                 | 23,216                 | 20,136                         |
| Nagaland                    | 7,345                  | 5,644                  | 12,435                 | 19,181                         |
| Puducherry                  | 2,477                  | 11,843                 | 24,593                 | 22,416                         |
| Punjab                      | 4,14,883               | 5,28,291               | 2,92,372               | 3,32,365                       |
| Rajasthan                   | 3,63,821               | 12,10,350              | 31,77,364              | 29,49,063                      |
| Sikkim                      | 1,932                  | 2,753                  | 4,649                  | 4,625                          |
| Tamil Nadu                  | 14,17,116              | 45,34,670              | 17,54,764              | 6,83,140                       |
| Telangana                   | -                      | 2,89,081               | 4,63,320               | 3,64,655                       |
| Tripura                     | 29,983                 | 45,661                 | 75,858                 | 63,710                         |
| Uttar Pradesh               | 3,13,827               | 4,89,414               | 8,04,951               | 7,63,200                       |
| Uttarakhand                 | 1,11,535               | 1,79,382               | 2,56,124               | 2,32,887                       |
| Total                       | 70,06,735              | 1,45,49,499            | 1,63,46,366            | 1,19,00,359                    |