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Ayushman Bharat Scheme
Ayushman Bharat Scheme has been announced by the Government of India in the Union Finance Budget 2018, which has two main pillars, setting up one lakh health and wellness centers in the country and connecting 10 crore families with health insurance cover of Rs 5.00 lakh per year.
The main aspects of Ayushman Bharat Scheme are as follows:-
The scheme will include deprived rural families from D-1 to D-7 (except D-6) identified in the Socio-Economic Caste Census (SECC) and identified business-based urban families. In addition to the beneficiaries identified in the Socio Economic Caste Census (SECC) under the Prime Minister’s National Health Security Mission under the Ayushman Bharat Mission, M.P. It has been decided by the government that supply eligibility slips and workers in the unorganized sector should also be included in food security. In the coming time, beneficiaries of other schemes or other sections of the society will also be considered for inclusion in this scheme.
Beneficiaries of Ayushman Bharat Scheme-
Total potentially eligible families – 1.08 crore families
For the treatment of beneficiaries identified in the Socio-Economic Caste Census (SECC), 60 percent of the expenditure will be borne by the Government of India and 40 percent by the state government. Madhya Pradesh government will bear 100 percent of the amount spent on the treatment of the beneficiaries being added to the said scheme.
Deen Dayal Health Security Council (DDSSP) “Niramayam”
To implement Ayushman Bharat Mission Scheme in the state, under the Madhya Pradesh Society Registration Act 1973, “Deen Dayal Swasthya Suraksha Parishad” has been registered on 07 July 2018, whose registration number is 01/ 01/01/34127/18. This council is working as a state health agency, under which the entire implementation of this scheme will be done.
For the present operation of “Deen Dayal Swasthya Suraksha Parishad (DDSSP) Niramayam”, “I.E.C. Bureau”, work has been started in Jai Prakash Hospital Complex, Bhopal.
In “Deen Dayal Swasthya Suraksha Parishad”, 3 councils have been constituted as follows:-
1. Advisory Council
2. Governing Council
3.Executive Council
Bank account
To operate the Ayushman Bharat Scheme, the council’s savings bank account has been opened in ICICI Bank by selecting the bank through open competition. The central share and revenue of the scheme will be deposited in this bank account. The said savings bank account has been linked to PFMS to receive the Centre’s share. All the required IT facilities for running the Ayushman Bharat Scheme will be available in the said savings account. The solutions will be provided by the Bank at its own expense.
Appointment of Transaction Advisory Team (TAT)-
For the implementation of the Ayushman Bharat Scheme, 05 consultants have been hired from KPMG at the rates approved by NICSI, who are health care experts, insurance experts (health sector), I.T. System Analyst, Expert in Public Procurement and Expert in Contract Management.
Implementation Support Agency (ISA)
E-tender has been issued on 15.08.2018 for the appointment of Implement Support Agency (ISA)
On the basis of which Vidal Health Insurance Company has been selected by adopting transparency.
Initially the appointment of the agency will be for 02 years, after the performance assessment this period can be extended for a maximum of 01 more year. To audit the work being done by the Implementation Support Agency (ISA), the appointment of Third Party Auditor will be done in a transparent manner by adopting online tender process.
District Implementation Unit (DIU)
For the successful implementation of Ayushman Bharat Scheme, as per the instructions of the Government of India, the District Implementation Unit (DIU) has been formed as follows, in which the already working officers will perform the duties of the posts mentioned against their designations in DIU along with their current responsibilities.
DIU which will include the following officers:-
District Collector – Chairman,
District Malaria Officer – District Nodal Officer
District Program Manager (NHM) – District Program Coordinator
District e-Governance Manager – District Information System Manager
District Media Officer – Public Grievance Redressal Manager
District Community Mobilizer – District Program Co-ordinator
Empanelment process
A Panel Approval Board has been constituted under the chairmanship of the Operating Hospital Administration. Under this Ayushman Bharat Scheme, the process related to empanelment/registration of all government hospitals, government medical colleges, private hospitals, private medical colleges etc. is being done online as per the instructions of the Government of India and the D.Panel process has been determined. going .
In the first phase, all district hospitals and government medical colleges have been considered as self-empaneled.
In the second phase, the target has been set to associate Community Health Centers (CHC) with the scheme.
In the third phase, the target has been set to associate PHC with the scheme.
The following criteria for private hospitals are set by the Government of India-
- NABH Affiliation,
- minimum 10 beds
- Compliance with Nursing Home Rules 1972
- All relevant norms issued by NHA for Super Specialty
- Trust/NGO The empanelment will be decided by a committee constituted at the government level.
Fixed package for treatment
Package rates for treatment have been fixed so that hospitals cannot arbitrarily charge for treatment and cost control can be maintained. These package rates have already been fixed by the government. The rate of Ayushman Bharat Yojana will include all types of treatment related expenses (medicines, tests, transport, pre-treatment, post-treatment expenses), which will include a total of 1350 packages of 23 specialties, 472 reserved packages for government hospitals as well as the facility of additional packages and Also includes 10 day follow up.
Payment of claims
Government and private hospitals will submit the claims along with all the necessary records and investigation reports to the Application Support Agency (ISA) within 10 days of the completion of the treatment and all the claims received online by the Application Support Agency will be examined within 15 days and will give its final recommendation. State Health Society (SHA) i.e. “Deen Dayal Swasthya Suraksha Parishad-Niramayam”. The claims will be paid by the Council to the concerned hospitals through online mode in their bank accounts within 05 days. In this way the entire claim related process will be completed in 30 (thirty) days.
Help Desk
Under the Ayushman Bharat Scheme, help desks have been created in all the hospitals related to the National Health Protection Mission (AB-NHPM) so that the beneficiary families included in the scheme can get all the information at one place and they do not face any difficulty in getting treatment. yes .
Launch of the scheme
Under the Ayushman Bharat Scheme, National Health Protection Mission (AB-NHPM) has been launched in the first phase in 08 districts and 02 medical colleges of the state on 15.08.2018 and in the second phase in 21 districts of the state on 27.08. 2018 and the pilot of the scheme was launched in the remaining 22 districts and remaining government medical colleges from 10.09.2018. The implementation of the scheme in the entire state was started on 23.09.2018.
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