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National Health Authority revises health benefit package of Ayushman Bharat PM-JAY

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Under latest revision of Health Benefit Package (HBP 2.2), rates for around 400 procedures have been revised with the addition of one new package related to black fungus

The National Health Authority (NHA) has revised the Health Benefit Package (HBP) Master under the scheme.

In the revised version of Health Benefit Package (HBP 2.2), rates of some health packages have been increased by 20 percent to 400 per cent under PM-JAY. Around, 400 procedure rates have been revised and one new additional medical management package related to black fungus have also been added.

According to the NHA, rate revision has been done in the following categories: (i) radiation oncology procedures, (ii) Medical Management procedures like procedure for dengue, acute febrile illness etc, (iii) surgical package treatment for black fungus, (iv) other procedures like Right/left heart catheterization, PDA closure, Arthrodesis, Cholecystectomy, appendicectomy etc.

Under medical management procedures, rates for ICU with ventilator has been revised by 100 percent, rates for ICU without ventilator by 136 percent, rates for HDU has been revised by 22 percent while prices for routine ward has been revised by 17 percent. The HBP 2.2 is expected to be rolled out from November, 2021.

Currently, Ayushman Bharat PM-JAY has 1669 treatment procedures out of which 1080 are surgical, 588 medical and one unspecified package.

Mansukh Mandaviya, Union Minister of Health and Family Welfare, said “I am glad that the revised version of Health Benefit Packages (HBP 2.2) will strengthen the empanelled hospitals to provide better healthcare services to the beneficiaries under Ayushman Bharat PM-JAY. The revised packages for oncology will enhance cancer care for the beneficiaries in the country. Addition of new packages related to black fungus will be a huge relief to the beneficiaries. I am sure that the rationalised HBP will further improve the uptake of scheme in private hospitals leading to reduced Out-of-Pocket Expenditure for the beneficiaries.”

Dr RS Sharma, CEO, National Health Authority (NHA) said, “We constantly work on the feedback received from stakeholders for rationalization of health benefit package master. Since the inception of the AB PM-JAY scheme, new packages have been added to cover more disease conditions and regular rates of the packages are being revised to provide better healthcare services. These changes are necessitated to ensure effective implementation of the scheme and will be made in the Transaction Management System (TMS) to ensure that there are no challenges in portability. State Health Agencies (SHAs) currently implementing any of the previous versions of HBP can now accept and implement the latest version of HBP 2.2. NHA is doing continuous consultation with stakeholders and eminent professors of premier medical institutes.”

In 2018, Ayushman Bharat PM-JAY was launched with the HBP 1.0 with a total of 1,393 packages. The scheme aims to provide free and cashless healthcare services up to Rs 5 lacs per family per year to over 10.74 crore poor and vulnerable families (over 53 crore beneficiaries) as per Socio-Economic Caste Census (SECC)-2011 database.

Since the inception of the scheme, more than 2.2 crore eligible AB-PMJAY beneficiary have been provided with health coverage for secondary, tertiary and day care procedures for treatment of diseases and medical conditions through a vast network of 24,000 empanelled Health Care Providers (EHCP).

As per National Health Authority, Health Benefit Package (HBP) is the backbone of AB PM-JAY scheme. It not only defines the scope of healthcare services being provided but also determines the extent of financial risk protection to the beneficiaries. Thus, HBP’s are designed to cover diseases with high incidence / prevalence rates and the diseases which contribute to the maximum Out of Pocket (OOP) expenditure.

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