Excelsior Correspondent
JAMMU, Jan 20: Chief Secretary Atal Dulloo presided over the 9th Governing Council Meeting of the State Health Agency (SHA) today, focusing on its performance and the future of the people-centric AB-PMJAY and AB-PMJAY SEHAT schemes.
Attendees included the ACS of the Higher Education Department, Principal Secretary of Finance, Secretary of Health & Medical Education (H&ME), Secretary of Rural Development Department (RDD), CEO of SHA, MD of NHM, Director of SKIMS, DG of Codes, DG of Budget, Principals of GMC Srinagar/Jammu, Directors of Health in Jammu/Kashmir, SIO from NIC, and other relevant officials.
During the meeting, the Chief Secretary evaluated the SHA’s effectiveness in implementing the AB-PMJAY and AB-PMJAY SEHAT schemes in Jammu and Kashmir. He emphasized the need for the health agency to adhere to new guidelines for AB-PMJAY, particularly regarding coverage for individuals above 70 years of age. He urged the relevant parties to address the redundancy in the issuance of Ayushman Bharat Gold Cards derived from various databases such as NFSA and SECC. Additionally, he called for the enhancement of the monitoring systems to eliminate opportunities for fraud by empaneled hospitals.
Dulloo requested that the officers develop new guidelines for claim utilization to guarantee the efficient execution of this complimentary health insurance scheme. He proposed the creation of a portal for public hospitals to facilitate improved management of fund transfers and their subsequent use by these facilities.
Concerning the impending policy cycle, the Chief Secretary highlighted the importance of verifying the feasibility of insurance rates submitted by bidders for household coverage. He instructed the formation of a committee, led by the DG of Codes, to evaluate necessary adjustments to each package for the public’s overall benefit.
As for the upcoming tender invitations to extend the scheme past March 14, 2025, Dulloo advised that the documentation should be clear and free from ambiguous terms or conditions. He suggested establishing a committee led by the Secretary of H&ME with members from the Finance and Law Departments to oversee this process, ensuring the smooth rollout of the scheme during the upcoming policy period.
The Council also reviewed the progress made since the last directives issued at the 8th Governing Council Meeting and the actions taken thus far.
Council members shared suggestions to further enhance SHA’s effectiveness and streamline the AB-PMJAY-SEHAT implementation.
The H&ME Secretary provided an update on the accomplishments under this scheme, noting that SHA is implementing the AB-PMJAY/AB-PMJAY SEHAT scheme in compliance with a High Court order. He also noted that the Anti-Fraud Unit has been bolstered with the addition of 12 doctors, along with the appointment of a neutral anti-fraud officer to scrutinize fraudulent claims within this scheme.
Regarding the performance metrics of the AB-PMJAY and PMJAY-SEHAT schemes, CEO of SHA, Sanjiv Gadkar, reported that out of 336,859 claims submitted to SHA, 122,839 claims amounting to Rs 222.58 crore have been processed and paid, while 3,198 claims have been rejected by the authorities to date.
