Chief Secretary, Atal Dulloo, today chaired the 9th Governing Council Meeting of State Health Agency (SHA) to review its performance and discuss way forward for continuation of people friendly AB-PMJAY and AB-PMJAY SEHAT scheme.
Those who attended included ACS, Higher Education Department; Principal Secretary, Finance; Secretary, H&ME; Secretary, RDD; CEO, SHA; MD, NHM; Director, SKIMS; DG, Codes; DG, Budget; Principal, GMC Srinagar/Jammu; Director Health, Jammu/Kashmir; SIO, NIC besides other concerned officers.
The Chief Secretary assessed the performance of SHA in implementation of AB-PMJAY and AB-PMJAY SEHAT schemes in J&K. He impressed upon the health agency to implement the renewed guidelines of AB-PMJAY especially coverage of 70 years above individuals.
He enjoined upon the concerned to look into the duplication in creation of Ayushman Bharat Gold Cards based upon different databases like NFSA/SECC. He directed for enhancing efficiency of the monitoring mechanism to weed out any chances of fraud by any of the empanelled hospitals.
Dulloo directed the concerned officers for framing fresh claim utilisation guidelines for effective implementation of this free health insurance scheme. He asked them to create a portal for public hospitals which would ensure better management of fund transfer and their subsequent utilisation by these health facilities.
Regarding the upcoming cycle of this policy, the Chief Secretary underscored the need for checking the reasonability of insurance rates quoted by tenderers to cover the households. He also directed to constitute a committee under the chairmanship of DG Codes with other members to review the extent to which each package needs to be tweaked for overall benefit of public.
Regarding the invitation of fresh tenders to continue the scheme beyond 14th of March, 2025, the Chief Secretary advised for making the document lucid without any doubtful terms/conditions being part of the bid document.
He asked for framing a committee under the chairmanship of Secretary, H&ME with members from Finance and Law Departments to overlook this process for smooth implementation of this scheme for the upcoming policy period.
The Council also took notice of progress on the previous directives given during its 8th Governing Council Meeting and the action taken, so far. The members also gave their suggestions to further improve the performance of SHA besides streamlining the implementation of PMJAY-SEHAT.
Secretary, H&ME, provided insights into the achievements accomplished under this scheme, so far. He revealed that SHA is currently implementing the AB-PMJAY/AB-PMJAY SEHAT scheme adhering to the High Court order.
He further apprised the meeting that the Anti-Fraud Unit has been strengthened by deploying 12 additional doctors there besides engaging a neutral anti-fraud officer to thoroughly look into the fraudulent claims made under this scheme.
Regarding the performance of AB-PMJAY and PMJAY-SEHAT scheme, CEO, SHA, Sanjiv Gadkar informed the meeting that out of the total claims of 3,36,859 submitted to SHA, 1,22,839 claims worth Rs 222.58 crore stands paid while 3198 claims have been rejected by the authorities till date.
It was added that claims of private hospitals had largely been cleared with latest status of all the claims made till October, 2024 stands paid by the health agency. Besides, all the high-end, emergency procedures are being given due priority by the agency in addition to the claims raised by private hospitals to run this scheme smoothly throughout J&K.