The step comes after the body included testing and treatment for COVID-19 in its packages for Ayushman Bharat beneficiaries
The National Health Authority, the apex body which implements the national health insurance scheme has started empanelling ICMR-registered laboratories directly, officials said.
The step comes after the body included testing and treatment for COVID-19 in its packages for Ayushman Bharat beneficiaries in view of the coronavirus pandemic.
The National Health Authority (NHA) released guidelines on the process of empanelment, according to which, the primary eligibility criteria for laboratory empanelment is ICMR registration and it will be applicable for all private laboratories.
The agency had been empanelling only hospitals till now under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojna (AB – PMJAY) and whatever services were required for providing care to patients, were provided by hospitals either in-house or through outsourcing.
Citizens eligible under the health insurance scheme are availing free-of-cost testing through private labs and treatment for COVID-19 in empanelled hospitals since April.
With the advent of COVID-19 pandemic, a need was felt to expand the testing capacity for the benefit of AB PM-JAY beneficiaries, hence, the packages for COVID-19 testing were notified by NHA, officials said.
“However, private laboratories urged the NHA that they want to get directly empanelled with the body so that there is no delay in bill payments, an official said.
“Following requests from the industry, it was decided to start empanelling the ICMR registered labs directly. So far one such lab has been empanelled while 13 others have applied and awaiting nod,” he said.
According to the guidelines, the NHA shall be approving the empanelment of laboratories in those states which are not implementing AB-PMJAY at present namely, Telangana, West Bengal, Delhi and Odisha.
Modules for empanelment of the labs have been developed and at present, NHA has decided to empanel only the ICMR registered labs, as only they are authorised to conduct COVID-19 tests, the guidelines said.
Considering the ground situation and to minimise the time for processing applications, states and Union territories may request for empanelment with minimum details and documents, they said.
To speed up the process of empanelment, the approval may be given by CEO, NHA or officer authorised by CEO, after verification of ICMR registration of the lab.
In case CEO, SHA has approved the empanelment, the process of scrutiny at the district level may be done post facto as per the instructions of state health authority (SHA), they said.
After the empanelment request by a laboratory is filed, the application shall be scrutinised by NHA within four days.
If the application is rejected, the laboratory will be intimated of the reasons based on which it was not accepted and the lab can approach the Grievance Redressal Mechanism for remedy.
In case the laboratory chooses to withdraw from the health insurance scheme, it will only be permitted to re-enter/ get re-empanelled under AB-PMJAY after a period of six months.
If a laboratory is blacklisted for a defined period due to fraud/abuse, after following due process, it can be permitted to re-apply after cessation of the blacklisting period or revocation of the blacklisting order, whichever is earlier, the guidelines added.