Govt hikes rates of procedures under Ayushman Bharat, black fungus management added under scheme

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The government has revised the rates of around 400 procedures under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and added a new medical package related to black fungus management, moves that "will strengthen the empanelled hospitals to provide better healthcare services".

In the revised Health Benefit Package (HBP 2.2), the National Health Authority (NHA) which implements the AB PM-JAY scheme has raised the rates of packages by 20 per cent to 400 per cent.

Under medical management procedures, the rates for ICU with ventilator support has been revised by 100 per cent and without ventilator by 136 per cent, while the rates for HDU (High Dependency Unit) has been revised by 22 per cent and the prices for routine ward has been revised by 17 percent, it said.

"In the revised version of Health Benefit Package (HBP 2.2), rates of some health packages have been increased by 20 percent to 400 per cent under PM-JAY. Around 400 procedure rates have been revised and one new additional medical management package related to black fungus has also been added," the ministry said.

Union Health Minister Mansukh Mandaviya said, "I am glad that the revised version of Health Benefit Packages (HBP 2.2) will strengthen the empanelled hospitals to provide better healthcare services to the beneficiaries under Ayushman Bharat PM-JAY.

"The revised packages for oncology will enhance cancer care for the beneficiaries in the country. Addition of new packages related to black fungus will be a huge relief to the beneficiaries. I am sure that the rationalised HBP will further improve the uptake of scheme in private hospitals leading to reduced out-of-pocket expenditure for the beneficiaries,” he said.

National Health Authority CEO Dr R S Sharma said the NHA constantly works on the feedback received from stakeholders for rationalisation of health benefit package.

State Health Agencies (SHAs) currently implementing any of the previous versions of HBP can now accept and implement HBP 2.2, Sharma said.

The NHA has undertaken rate revision in the categories which include radiation oncology procedures, medical management procedures like those for dengue, acute febrile illness etc, surgical package treatment for black fungus and other procedures like right/left heart catheterisation, PDA closure, arthrodesis, cholecystectomy, appendicectomy etc.

Currently, Ayushman Bharat PM-JAY covers 1,669 treatment procedures out of which 1,080 are surgical, 588 medical and one unspecified package.

The Ayushman Bharat PM-JAY aims to achieve the target of universal health coverage and provide access to free and affordable healthcare services to the citizens residing in the remotest of the areas.

In 2018, Ayushman Bharat PM-JAY was launched with the HBP 1.0 with a total of 1,393 packages.

The scheme aims to provide free and cashless healthcare services up to Rs 5 lakh per family per year to over 10.74 crore poor and vulnerable families (over 53 crore beneficiaries) as per Socio-Economic Caste Census (SECC)-2011 database.

Since the inception of the scheme, more than 2.2 crore eligible AB-PMJAY beneficiary have been provided with health coverage for secondary, tertiary and day care procedures for treatment of diseases and medical conditions through a vast network of 24,000 Empanelled Health Care Providers (EHCP), the statement said.

The Health Benefit Package (HBP) defines the scope of healthcare services being provided and also determines the extent of financial risk protection to the beneficiaries, the statement said.