Ayushman Bharat Pradhan Mantri Jan Arogya Yojana Quarterly

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana Quarterly Review Meeting (Group 2)| 20 th Sept 2019 Dr Praveen Gedam | Deputy CEO, NHA 1

PM-JAY Report Card: Good Momentum has been created… 10. 3 Crore Beneficiaries Verified 44 lakh worth Rs. 6, 8 29 crores Hospital Admissions 18, 188 + Hospitals Empanelled 42, 000 + Portability cases 2 2

Agenda of Arogya Manthan (1/2) 3

Agenda of Arogya Manthan (2/2) 4

Action Items for 1 year celebration ● ● ● ● ● Ayushman Bharat Arogya Manthan shall be on 30 th Sept. and 1 st Oct. Send itinerary and arrange for travel of nominated beneficiaries/ PMAMs/Hospitals/CSE VLEs before 23 rd Sep Confirm the presence of ACS/Pr. Sec (Health) Confirm the participation of Hon'ble Health Minister (invitations have been shared) SHA should share the participation details of their officials Pr. Sec should present the working group outcome to HFM Interaction with the nominated beneficiaries Organising Ayushman Bharat Diwas on 23 rd PSD file of Comic Book has been shared, State may use it Selected states may share details of special requirement for market place 5

Percentage of eligible families with PM-JAY e-Cards States/UTs should take drive to distribute e. Cards 6

Experience till now: Awareness 7

Experience till now: Awareness 8

Penetration of PM-JAY e-cards in Uttar Pradesh 9

Penetration of treatment and active hospitals in Uttar Pradesh 10

Pending e-Card approvals 11

Claims overdue State-wise 12

Portability payments pending 13

Payments pending for National Institutes of Eminence 14

Release of Grant-in-aid action points States/UTs yet due to release their share S No. State 1 Daman & Diu 2 Gujarat 3 Maharashtra States/UTs yet to submit Utilisation Certificates S No. 1 State Daman & Diu 15

Key decisions from NHA Governing Board meeting 1. Rationalisation of Health Benefit Packages • Discontinuation of packages • Reduction in rates of packages • Addition of packages • Increase in rates of packages • Adoption of stratified packages 2. PM-JAY Bronze Quality Certification Standards have been approved 3. Approval of PM-JAY IT 2. 0 for further upgradation of systems States/UTs may consider aligning their HBPs of various schemes with these. 16

Status of renewal of Insurance Contracts S No. State Description 1 Daman & Diu Renewal due on 22 nd Sept 2019. 2 Gujarat Renewal due on 22 nd Sept 2019. 3 Maharashtra Renewal due on 22 nd Sept 2019. 17

PMJAY - Centralised Public Grievance Redressal and Monitoring System (CPGRAMS)- Pending Status 18

PMJAY Central Grievance Redressal- Pending status 19

National Call Centre integration with State Call centre • States where integration is completed - Punjab - Uttar Pradesh (East) - Maharashtra • States where integration support required • • • Assam Arunachal Pradesh Gujarat Haryana Karnataka (request pending) • • • Madhya Pradesh Manipur Mizoram Rajasthan Utter Pradesh (West) # of phone calls made per executive per day should be around 100. If no of incoming calls are less, outgoing calls should be made to beneficiaries to seek the feedback. 20

Human resources in some States/UTs and their districts needs to be strengthened… States & UTs Arunachal Pradesh Chandigarh Daman & Diu Madhya Pradesh Manipur Mizoram 21

Other Items 1. 2. 3. 4. 5. 6. 7. 8. Bio. Auths- pilots must in Sept. Compulsory from Oct. for all states/UTs. Data Warehouse to be set up by all States requiring Data from our end Integration on API Gateway by all brownfield States All eligible inpatients/day care patients coming to hospitals should be converted into PM-JAY. A flexi-fund may be maintained at the hospital level for – diagnostics, drugs, consumables, implants, transportation, loss of wages, incentives to staff, etc. Suitable GOs needs to be issued. Forward and backward linkages / referrals to ensure continuum of care Publicity of the scheme in the hospital. Help desks. Trainings of doctors 22

Status of Anti-fraud responses from States 23

To conclude 1. Ayushman Bharat Arogya Manthan (30 th Sept. to 1 st Oct) 2. Increase generation of e-Cards/Golden Cards 3. Convert in-patients into pre-authorisation of PM-JAY (Check PM-JAY eligibility of all in-patients) 4. Faster settlement of hospital claims (15 day TAT compliance) 24

Thank You

9766620000 Praveen Gedam 26