Beneficiaries under the Narendra Modi government’s Ayushman Bharat national public health insurance scheme will now be able to opt for medical procedures that are not part of the designed health benefit packages, News18.com has learnt.
The governing panel of the Ayushman Bharat scheme has allowed flexibility to states and union territories for deciding and approving the procedures to be booked under the unspecified surgical package up to Rs 5 lakh.
Also, states have been allowed to decide the prices of health benefit packages (HBPs) – the list of procedures given to beneficiaries under the scheme – and choose relevant packages suited to the local context.
The Ayushman Bharat programme was launched by Prime Minister Narendra Modi in 2018 with the aim to provide healthcare benefits to crores of Indians who cannot afford proper medical facilities.
The National Health Authority (NHA) – the department responsible for the execution of the scheme – says it has taken care to cover a large number of treatment procedures under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) but in several cases, patients had to undergo treatment for procedures not defined under health benefit packages.
In such cases, patients are registered by using the category of unspecified surgical procedures (USPs).
“We convinced the governing board by sharing our concern that the existing process is time-consuming. Granting flexibilities to states will bring relief to the beneficiaries as decisions regarding such packages can be taken expeditiously,” said an NHA official.
Over the course of the implementation of the scheme, meanwhile, several states have already set up their own medical cells to advise on several aspects of the scheme. “These states now possess sufficient technical expertise for taking decisions on USPs,” the official added.
The governing board – which is headed by union minister of health Mansukh Mandaviya – approved the proposal to give complete flexibility to states and UTs to decide the packages from the financial year 2022-2023.
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It also approved the motion to delegate authority to states and UTs for approving unspecified packages up to Rs 5 lakh.
However, the NHA may decide appropriate procedures for decision-making regarding unspecified surgical procedures along with the incorporation of necessary audit mechanisms.
“Details of all such expenditure on USP above Rs 1 lakh should be brought before the governing board for clearance,” said the official.
