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Govt Proposes Rates for Treatment Under Health Protection Scheme

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Govt Proposes Rates for Treatment Under Health Protection Scheme
Scheme likely to be rolled out by Aug, registration for hospitals expected to begin by June 15
The government has proposed rates for over 1,350 treatment packages ranging from Rs 1,000 to over Rs 1.50 lakh, for the Pradhan Mantri Rashtriya Swasthya Suraksha Mission.The government issued a 205-page model tender document on Wednesday, taking the Prime Minister’s ambitious health protection scheme a step closer to implementation. The rates proposed depend on the type of therapy and procedure.
The document is expected to help states select insurance companies for the scheme, which promises up to Rs 5 lakh cover for 100 million poor families in the country.Over 20 specialties like cardiology, cancer care, neurosurgery and neo-natal care have been covered in the draft.For instance, the rate for an orthopaedic procedure like application of skin traction has been set at Rs 1,000, while aortic arch replacement under cardio thoracic surgery would be Rs 1.60 lakh.
Around 610 of the 1,354 packages listed would be mandated for pre-authorisation by the insurance company, according to the draft.Hospitals accredited by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) will be allowed to charge 10-15% more than the rates set in this document, said Indu Bhushan, chief executive officer, Ayushman Bharat National Health Protection Mission.
The insurer is not liable to make any payments under the policy for expenses incurred in conditions that do not require hospitalisation, congenital external diseases, fertility-related procedures, vaccinations, suicide and persistent vegetative state.“There was a very rigorous process used (to decide the package rates). We looked at packages including CGHS, packages from all different states and our experience with RSBY. Based on that, the first draft was prepared and peer-reviewed by Niti Aayog,” he told ET.
“These (guidelines) are only indicative. States have been given the flexibility to look at them and they may make some changes,” he said.The registration process for hospitals are expected to begin by June 15, while the states are expected to be in charge of the bidding process for insurance companies, he said.“The states hopefully should start this process in a couple of weeks,” said Bhushan, adding that the scheme will be ready for a roll-out by August.
The Economic Times, New Delhi, 24th May 2018

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