Punjab govt in talks with health ministry over Ayushman Bharat backlog

Sources indicate Punjab state health agency has not submitted audit reports since 2020-21

The Government of Punjab is in touch with the Ministry of Health and Family Welfare to discuss the delayed payments to private hospitals under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), senior officials in the know said.  

This comes after the Private Hospital and Nursing Home Association (PHANA), Punjab, and state chapter of the Indian Medical Association (IMA) announced suspension of all treatment under the scheme in state’s empanelled private hospitals.

They claimed unresolved payments worth Rs 600 crore were pending for the last six months. 

An email sent to the Punjab health department did not elicit a response.

The memorandum of understanding (MoU) signed between the state health agency (SHA) and hospitals at the time of empanelment states that the payment for each case must be completed within 15 days of a patient’s discharge. 

For every payment that remains pending after 15 days, the agency has to pay an interest of 1 per cent.

Punjab had integrated its state health insurance scheme with AB-PMJAY in August 2019, christenting it as Ayushman Bharat PM-JAY Mukh Mantri Sehat Bima Yojana (AB PM-JAY MMSBY).

The scheme provides eligible beneficiaries with an insurance of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation. It enables cashless treatment across government and private empanelled hospitals in India. 

The PMJAY covers households based on the deprivation and occupational criteria of the socio-economic Caste Census (SECC) 2011 for rural and urban areas. The state scheme adds coverage of additional categories such as ration card holders, small and marginal farmers and construction workers registered with the state. 

The cost of premium for 1.66 million SECC beneficiary families is borne by both central and state governments in a 60:40 ratio.

The premium cost of the remaining 2.21 million beneficiary families is completely borne by the state.

Commenting on the issue, a senior official said the Centre has no arrears currently as it gives its share whenever the demand comes. “States have to add their 40 per cent share to our 60 per cent to complete the demands,” an official added.

Sources also pointed out that the Punjab SHA has only provided audit reports till 2020-21. “These reports, along with utilisation certificates help get a final figure, which then is funded accordingly,” sources added.   

“Punjab is in the process to submit the remaining audit reports,” sources said. 

Senior officials also negated the possibility of a software glitch being the reason behind delay in payments. This was claimed by Punjab SHA, according to reports.

CASE FILE
 

- Move comes after the Private Hospital and Nursing Home Association, Punjab, and the IMA announced suspension of all treatment under AB-PMJAY 

- It was claimed that unresolved payments worth Rs 600 crore were pending for the last six months in the state’s empaneled private hospitals 

- The MoU signed between the state health agency and hospitals states that payment for each case must be completed within 15 days of a patient’s discharge

- Punjab had integrated its state health insurance scheme with AB-PMJAY in August 2019. The scheme provides an insurance of Rs 5 lakhs per family per year