PM’s Ayushman Bharat Scheme in dire straits in J&K
Gopal Sharma
JAMMU, Apr 18: Prime Minister’s Flagship Scheme- ‘Pradhan Mantri Jan Arogya Yojna’ (PMJAY), popularly known as ‘Ayushuman Bharat Scheme’ is in dire straits in Jammu and Kashmir at the time when the PM Narendra Modi is about to visit J&K himself on April 24.
In sheer violation of PMJAY Policy and the standing rules, the Lt Governor’s Administration in J&K has failed to clear an amount of nearly Rs 68 crores of the Government empanelled hospitals despite the clear directives from the Union Health Ministry that this amount must be cleared to the concerned hospitals within 15 days.
Official sources told the Excelsior that out of the total Rs 68 crores liability generated during the last four months, Rs 31 crores is the amount yet to be paid to the private empanelled hospitals. Rest of the amount pertains to the Government authorized hospitals under the Ayushuman Scheme. As per MoU, the Insurance company Bajaz Alianz has to pay the claim amount to the hospitals but surprisingly the Insurance company has itself not received premium amount from the J&K Health Department for many months now.
It said many private hospitals are sourcing medicines and other consumables from suppliers on short time basis on credit and with this crisis, a lot of serious liabilities have accrued for all of them. Most of the private hospitals in J&K are like small nursing homes, who sustain hand to mouth and can’t withstand this severe cash crunch even though they have given free treatment to thousands of patients under the Scheme, the sources added.
Sources further revealed that the additional top up special ‘Sehat Scheme’ for J&K which extends coverage to all the people, not only to the BPL, but also the APL category, was launched by the Prime Minister Modi himself on December 25, 2019. Over 66 lakhs people have been issued Ayushuman Health Golden Cards by the Government to the people of J&K so far while the process still continued.
“While 165 Government and private hospitals including Narayana-Katra and ASCOMS/ Batra Hospital of Jammu have been empanelled in Jammu and Kashmir under the Scheme but any Golden Card holder from J&K can avail free Medical treatment up to Rs 5 lakhs in about 25,000 empanelled hospitals through out the country by producing this card issued under PM’s Flagship Programme. But shockingly many card holders are facing difficulty for the last few months here as majority of the empanelled hospitals are avoiding to entertain such patients as they have remained unpaid by the concerned Insurance company for months. This has badly affected the patients in J&K and also bringing bad name to the PM’s popular Ayushuman Scheme,” the sources disclosed.
The source said that the agreement with the previous Insurance Company, Bajaz Alianz was expired on March 15, 2021 and now the MoU has been signed with the new Insurance Company- IFFCO Tokyo for the next year. This liability pertains to the last four months from December 2021 to March 2022.
” The delay in reimbursement to hospitals is in violation of PMJAY rules as there is mandated turn around time (TAT) of 15 days, which clearly indicates that hospitals must receive funds within 15 days since the acceptance of the claims,” the sources maintained.
A senior officer in the Health and Medical Education Department when contacted refused to comment but said that matter is said to be referred to the Finance department for the release of funds. Moreover, Lt Governor’s office was also well aware of the matter. He said though matter does not pertained directly to him, but it is said that funds have been received from the Government of India by the J&K Government for the purpose but are not being released by the people at the helm of affairs, for the reasons best known to them.
A senior representative from Bajaz Alianz, Uday when contacted said their contract with the J&K Government was over on March 15, 2022. He said they will certainly release the funds as and when these are received from the concerned authorities. He refused to share more details of the funds and the case, but claimed that it was under process and the company was following it vigorously.
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