Lok Sabha Question No. 2754 (UNSTARRED), answered on 2023-08-04
Subject: Coverage under AB-PMJAY
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Himadri Singh, Ramcharan Bohra, Sanjay Seth, Chandra Prakash Choudhary

## GOVERNMENTOFINDIA MINISTRYOF HEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH AND FAMILYWELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2754 TO BE ANSWERED ON 04 TH AUGUST, 2023

## COVERAGE UNDER AB-PMJAY

## 2754. SHRIMATI HIMADRI SINGH: SHRI RAMCHARAN BOHRA: SHRI SANJAY SETH: SHRI CHANDRAPRAKASH CHOUDHARY:

Will the Minister of HEALTHAND FAMILYWELFARE be pleased to state:

- (a) the total number of public and private sector hospitals functioning under the Pradhan Mantri Ayushman Bharat Yojana (AB-PMJAY), State/UT-wise and district-wise in Jharkhand;
- (b) the details of the provisions made for the private hospitals willing to empanel under the Yojana;
- (c) the total amount of funds allocated by the Government under this Scheme, State/UT-wise;
- (d) the percentage of people out of the total population of the country benefitted under this Scheme;
- (e) whether the hospitals empanelled under AB-PMJAY are bound to offer treatment and if so, the details thereof;
- (f) whether there is a provision to take action against the empanelled hospitals for refusing treatment under AB-PMJAY and if so, the details thereof; and
- (g) the details of the diseases for which treatment is covered under the Yojana including leprosy, skin disease and cancer etc. along with the disease-wise details of hospitals specialized for treatment under the AB-PMJAY in Jharkhand?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (PROF. S. P. SINGH BAGHEL)

(a) to (g): State/UT-wise details of total number of public and private hospitals empanelled under Ayushman Bharat -Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) are at Annexure-I . District-wise details of total number of public and private hospitals empanelled under the scheme in the State of Jharkhand are at Annexure-II .

State Health Agencies (SHAs) are mandated with the responsibility of empaneling hospitals under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Intending private hospitals get empanelled after fulfilling the laid down criteria and are subject to the requirement of SHA within a given State/UT. States/UTs are also given flexibility to change hospital empanelment criteria based on the local requirement.

Hospitals are empanelled under two types of empanelment criteria which are as follows:

-  General criteria - for hospitals that provide non-specialised general medical and surgical care with or without ICU and emergency services.
-  Special criteria (for clinical specialties) - for each specialty, a specific set of criteria is identified. In order to offer a specialized clinical service, the hospital must have necessary specific infrastructure and HR in place as laid down in the special criteria developed under the scheme.

Funds are released to States/UTs only after utilization certificate is submitted by them. The details of budget allocated and funds utilized under the scheme are as under:

(in crore of Rupees)

| Financial Year   |   Budget Estimate |   Revised Estimate |   Funds Utilized |
|------------------|-------------------|--------------------|------------------|
| 2018-19          |              2400 |               2160 |           1849.5 |
| 2019-20          |              6400 |               3200 |           2992.9 |
| 2020-21          |              6400 |               3100 |           2544.1 |
| 2021-22          |              6400 |               3199 |           2940.6 |
| 2022-23          |              6412 |               6412 |           6048   |
| 2023-24          |              7200 |               7200 |           1855   |

AB-PMJAY aims to provide health cover of Rs. 5 lakh per family per year for secondary and tertiary care hospitalization to 55 crore individuals corresponding to 12 crore families constituting the bottom 40% population of the country. Many States/UTs implementing ABPMJAY have expanded the beneficiary base to approximately 15.5 crore families at their own cost.

Any hospital empanelled under the scheme cannot deny treatment to eligible beneficiaries for the specialities it is empanelled for. It may result in penal action, which may include deempanelment. In case of denial of treatment by the empanelled hospital, beneficiaries can lodge grievances on the designated portal of Central Grievance Redressal Management System (CGRMS). Alternatively, beneficiaries can reach out to National Call Centre through 24x7 helpline 14555 or through mail, letter, fax and register their grievances. Such grievances are resolved in an efficient and transparent manner through a three-tier grievance redressal structure.

AB-PMJAY provides treatment corresponding to a total of 1,949 procedures under 27 different specialties including diseases such as Cancer, Diabetes, Heart Disease, and other diseases. 26 procedures related to skin diseases and 549 procedures related to cancer are covered under the scheme. Further, there is a provision of one unspecified package to ensure that eligible beneficiaries can avail treatment for such procedures that do not feature in Health Benefit Packages (HBPs). Details of HBPs are available at the following link:

https://pmjay.gov.in/sites/default/files/2022-04/HBP%202022%20..pdf

Specialty-wise details of hospitals empanelled in the State of Jharkhand are available at the following link:

https://acrobat.adobe.com/link/track?uri=urn:aaid:scds:US:659cec5c-65b2-346e-aff0-26942778a 916

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## State/UT-wise details of total number of public and private hospitals empanelled under AB-PMJAY

| State/UT                    | Private Hospitals   | Public Hospitals   |
|-----------------------------|---------------------|--------------------|
| Andaman And Nicobar Islands | -                   | 7                  |
| Andhra Pradesh              | 1,213               | 1,449              |
| Arunachal Pradesh           | 1                   | 61                 |
| Assam                       | 161                 | 167                |
| Bihar                       | 354                 | 607                |
| Chandigarh                  | 22                  | 7                  |
| Chhattisgarh                | 553                 | 1,021              |
| Dadra And Nagar Haveli      | 23                  | 4                  |
| Daman And Diu               | 9                   | 3                  |
| Delhi                       | 51                  | 34                 |
| Goa                         | 6                   | 15                 |
| Gujarat                     | 803                 | 1,727              |
| Haryana                     | 601                 | 175                |
| Himachal Pradesh            | 124                 | 146                |
| Jammu And Kashmir           | 112                 | 117                |
| Jharkhand                   | 441                 | 280                |
| Karnataka                   | 511                 | 2,975              |
| Kerala                      | 411                 | 202                |
| Ladakh                      | -                   | 10                 |
| Lakshadweep                 | -                   | 6                  |
| Madhya Pradesh              | 517                 | 494                |
| Maharashtra                 | 745                 | 225                |
| Manipur                     | 31                  | 70                 |
| Meghalaya                   | 18                  | 169                |
| Mizoram                     | 7                   | 89                 |
| Nagaland                    | 21                  | 87                 |
| Odisha                      | 2                   | 26                 |
| Puducherry                  | 19                  | 12                 |
| Punjab                      | 646                 | 223                |
| Rajasthan                   | 400                 | 973                |
| Sikkim                      | 3                   | 16                 |
| Tamil Nadu                  | 1,300               | 1,283              |
| Telangana                   | 325                 | 1,020              |
| Tripura                     | 4                   | 144                |
| Uttar Pradesh               | 2,416               | 1,119              |
| Uttarakhand                 | 139                 | 123                |
| West Bengal                 | 3                   | 62                 |

Note: State/UT of Odisha, West Bengal and Delhi are not implementing AB-PMJAY. Hospitals are empanelled in these States/UT to facilitate beneficiaries of implementing States/UTs to avail treatment under the portability feature of the scheme.

## District-wise details of total number of public and private hospitals empanelled under AB-PMJAY in the State of Jharkhand

| District            |   Private Hospitals |   Public Hospitals |
|---------------------|---------------------|--------------------|
| Bokaro              |                  27 |                 18 |
| Chatra              |                   5 |                  8 |
| Deoghar             |                  22 |                  9 |
| Dhanbad             |                  37 |                 16 |
| Dumka               |                   7 |                 12 |
| East Singhbum       |                  30 |                 17 |
| Garhwa              |                   7 |                 12 |
| Giridih             |                  21 |                 13 |
| Godda               |                  18 |                  9 |
| Gumla               |                   3 |                 12 |
| Hazaribagh          |                  30 |                 14 |
| Jamtara             |                   5 |                  5 |
| Khunti              |                   2 |                  8 |
| Koderma             |                  14 |                  7 |
| Latehar             |                   2 |                  9 |
| Lohardaga           |                  13 |                  6 |
| Pakur               |                   7 |                  8 |
| Palamu              |                  26 |                 11 |
| Ramgarh             |                  24 |                  8 |
| Ranchi              |                 101 |                 32 |
| Sahebganj           |                   4 |                  7 |
| Saraikela Kharsawan |                  21 |                  9 |
| Simdega             |                   3 |                  7 |
| West Singhbhum      |                  12 |                 23 |

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