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) scheme, senior officials in the know said.
This comes after the Private Hospital and Nursing Home Association (PHANA), Punjab, and the state chapter of the Indian Medical Association (IMA) announced the suspension of all treatment under the scheme in the state’s empanelled private hospitals, claiming unresolved payments worth Rs 600 crore pending for the last six months.
An email sent to the Punjab health department did not elicit an immediate 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, christening it as Ayushman Bharat PM-JAY Mukh Mantri Sehat Bima Yojana (AB PM-JAY MMSBY). The scheme provides eligible beneficiaries with insurance of Rs 5 lakh per family per year for secondary and tertiary care hospitalisation, enabling cashless treatment across public and private empanelled hospitals in India.
While 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 for additional categories such as ration card holders, small and marginal farmers, and construction workers registered with the state.
The cost of the premium for 16.65 lakh SECC beneficiary families is borne by both central and state governments in a 60:40 ratio, whereas the premium cost of the remaining 22.12 lakh beneficiary families is completely borne by the state.
Commenting on the issue, a senior official said that 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 meet the demand,” he added.
Sources also pointed out that the Punjab SHA has only provided audit reports till 2020–21. “These reports, along with utilisation certificates, help to get a final figure, which is then funded accordingly,” sources added.
“Punjab is in the process of submitting the remaining audit reports,” sources said.
Senior officials also negated the possibility of a software glitch being the reason behind the delay in payments, as was claimed by the Punjab SHA, according to reports.
First Published: Sep 23 2024 | 8:04 PM IST
